Clinical outcomes and management of patients with chronic hepatitis B and liver stiffness measurement in the grey zone
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AbstractA 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.
All Author(s) ListLiu K, Wong VWS, Liang LY, Lui GCY, Chan HLY, Wong GLH
Journal nameLiver International
Year2019
Month3
Volume Number39
Issue Number3
PublisherWILEY
Pages494 - 502
ISSN1478-3223
eISSN1478-3231
LanguagesEnglish-United Kingdom
Keywordschronic hepatitis B, grey zone, liver stiffness measurement, liver-related events
Web of Science Subject CategoriesGastroenterology & Hepatology;Gastroenterology & Hepatology

Last updated on 2020-25-05 at 00:34