Department of Internal Medicine, Virginia Commonwealth University (VCU), Richmond, USA.
Division of Gastroenterology and Hepatology, VCU, MCV Campus, West Hospital, 1200 E. Broad St, PO Box 980341, Richmond, VA, 23298-0341, USA.
Dig Dis Sci. 2024 May;69(5):1844-1851. doi: 10.1007/s10620-024-08366-0. Epub 2024 Mar 18.
Vibration-controlled transient elastography (VCTE) based liver stiffness measurement (LSM) is an excellent 'rule-out' test for advanced hepatic fibrosis in liver transplant (LT) recipients, however, its ability to 'rule-in' the disease is suboptimal. The study aimed to improve diagnostic performance of LSM in LT recipients.
Adult LT recipients with a liver biopsy and VCTE were included (N = 150). Sequential covering analysis was performed to create rules to identify patients at low or high risk for advanced fibrosis (stage 3-4).
Advanced hepatic fibrosis was excluded in patients with either LSM < 7.45 kPa (n = 72) or 7.45 ≤ LSM < 12.1 kPa and time from LT < 5.6 years (n = 25). Conversely, likelihood of advanced fibrosis was 95% if patients had LSM > 14.1 and controlled attenuation parameter > 279 dB/m (n = 21). Thus, 118 (79%) were correctly identified and 32 (21%) would have required a biopsy to establish the diagnosis. Compared to previously established LSM based cutoff values of 10.5 kPa (Youden index) and 13.3 kPa (maximized specificity), the false positive rates of sequential covering analysis was 1% compared to 16.5% with LSM ≥ 10.5 kPa and 8.3% with LSM ≥ 13.3 kPa. The true positive rates were comparable at 87% for sequential covering analysis, 93% for LSM ≥ 10.5 kPa and 83% for LSM ≥ 13.3 kPa.
The proposed clinical sequential covering analysis allows for better risk stratification when evaluating for advanced fibrosis in LT recipients compared to LSM alone. Additional efforts are necessary to further reduce the number of patients with indeterminate results in whom a liver biopsy may be required.
基于振动控制瞬时弹性成像（VCTE）的肝脏硬度测量（LSM）是肝移植（LT）受者中晚期肝纤维化的优秀“排除”检测方法，但它对疾病的“诊断”能力并不理想。本研究旨在提高 LT 受者 LSM 的诊断性能。
纳入接受肝脏活检和 VCTE 的成年 LT 受者（N=150）。进行连续覆盖分析以创建规则，以识别晚期纤维化（3-4 期）风险低或高的患者。
如果 LSM<7.45 kPa（n=72）或 7.45≤LSM<12.1 kPa 且 LT 后时间<5.6 年（n=25），则排除晚期肝纤维化。相反，如果患者的 LSM>14.1 且受控衰减参数>279 dB/m（n=21），则晚期纤维化的可能性为 95%。因此，118 例（79%）患者得到正确识别，32 例（21%）患者需要进行活检以确诊。与之前建立的 10.5 kPa（Youden 指数）和 13.3 kPa（最大特异性）的 LSM 截断值相比，连续覆盖分析的假阳性率为 1%，而 LSM≥10.5 kPa 为 16.5%，LSM≥13.3 kPa 为 8.3%。连续覆盖分析的真阳性率为 87%，LSM≥10.5 kPa 为 93%，LSM≥13.3 kPa 为 83%，结果相当。
与单独使用 LSM 相比，所提出的临床连续覆盖分析可在评估 LT 受者晚期纤维化时进行更好的风险分层。需要进一步努力，以进一步减少需要进行肝活检的不确定结果患者数量。
