Clinical outcomes and management of patients with chronic hepatitis B and liver stiffness measurement in the grey zone
© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd..
BACKGROUND: A significant number of patients have liver stiffness measurements in the grey zone where liver biopsy is recommended.
AIMS: To study chronic hepatitis B patients with initial liver stiffness measurements in the grey zone with regards to rates of liver biopsy, repeat liver stiffness measurements and outcomes.
METHODS: Consecutive chronic hepatitis B patients who underwent transient elastography from August 2006 to July 2017 were retrospectively studied. Liver-related events were defined as hepatocellular carcinoma or cirrhotic complications. Grey zone was defined as liver stiffness measurements: 6.1-9.0 kPa (normal ALT) or 7.6-12.0 kPa (ALT 1-5 × upper limit of normal) on M-probe and 6.9-10.0 kPa on XL-probe.
RESULTS: Of the 3212 patients analysed, 837 (26%) had initial liver stiffness measurements in grey zone. Only 3.6% of grey zone patients proceeded to liver biopsy within 6 months of transient elastography, of which 33% had METAVIR F3-4 fibrosis. Repeat liver stiffness measurements was performed in 44% of grey zone patients. Liver biopsy and repeat liver stiffness measurements prompted change in management in 47% and 31% of patients respectively. Independent predictors for liver-related events in grey zone patients included increased age, low albumin and low platelet count. Liver-related events rates were increased (9%-17%) in patients with METAVIR > F2 fibrosis on biopsy or repeat liver stiffness measurements which did not improve.
CONCLUSIONS: Chronic hepatitis B patients with initial liver stiffness measurements in the grey zone rarely proceed to a clarifying liver biopsy which would reveal advanced fibrosis or cirrhosis in one-third of patients. Both liver biopsy and repeat liver stiffness measurements in grey zone patients have clinical utility in prompting changes in management and providing prognostic information.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:39 |
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| Enthalten in: |
Liver international : official journal of the International Association for the Study of the Liver - 39(2019), 3 vom: 15. März, Seite 494-502 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Liu, Ken [VerfasserIn] |
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| Links: |
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| Themen: |
Chronic hepatitis B |
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| Anmerkungen: |
Date Completed 13.04.2020 Date Revised 13.04.2020 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/liv.14001 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM290502403 |
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| 245 | 1 | 0 | |a Clinical outcomes and management of patients with chronic hepatitis B and liver stiffness measurement in the grey zone |
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| 500 | |a Date Revised 13.04.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. | ||
| 520 | |a BACKGROUND: A significant number of patients have liver stiffness measurements in the grey zone where liver biopsy is recommended | ||
| 520 | |a AIMS: To study chronic hepatitis B patients with initial liver stiffness measurements in the grey zone with regards to rates of liver biopsy, repeat liver stiffness measurements and outcomes | ||
| 520 | |a METHODS: Consecutive chronic hepatitis B patients who underwent transient elastography from August 2006 to July 2017 were retrospectively studied. Liver-related events were defined as hepatocellular carcinoma or cirrhotic complications. Grey zone was defined as liver stiffness measurements: 6.1-9.0 kPa (normal ALT) or 7.6-12.0 kPa (ALT 1-5 × upper limit of normal) on M-probe and 6.9-10.0 kPa on XL-probe | ||
| 520 | |a RESULTS: Of the 3212 patients analysed, 837 (26%) had initial liver stiffness measurements in grey zone. Only 3.6% of grey zone patients proceeded to liver biopsy within 6 months of transient elastography, of which 33% had METAVIR F3-4 fibrosis. Repeat liver stiffness measurements was performed in 44% of grey zone patients. Liver biopsy and repeat liver stiffness measurements prompted change in management in 47% and 31% of patients respectively. Independent predictors for liver-related events in grey zone patients included increased age, low albumin and low platelet count. Liver-related events rates were increased (9%-17%) in patients with METAVIR > F2 fibrosis on biopsy or repeat liver stiffness measurements which did not improve | ||
| 520 | |a CONCLUSIONS: Chronic hepatitis B patients with initial liver stiffness measurements in the grey zone rarely proceed to a clarifying liver biopsy which would reveal advanced fibrosis or cirrhosis in one-third of patients. Both liver biopsy and repeat liver stiffness measurements in grey zone patients have clinical utility in prompting changes in management and providing prognostic information | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a chronic hepatitis B | |
| 650 | 4 | |a grey zone | |
| 650 | 4 | |a liver stiffness measurement | |
| 650 | 4 | |a liver-related events | |
| 700 | 1 | |a Wong, Vincent W S |e verfasserin |4 aut | |
| 700 | 1 | |a Liang, Lilian Y |e verfasserin |4 aut | |
| 700 | 1 | |a Lui, Grace C Y |e verfasserin |4 aut | |
| 700 | 1 | |a Chan, Henry L Y |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, Grace L H |e verfasserin |4 aut | |
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