Interobserver concordance in the assessment of liver fibrosis in HIV/HCV-coinfected patients using transient elastometry

• Published in: European journal of gastroenterology & hepatology Vol. 22; no. 7; p. 801
• Main Authors: Neukam, Karin, Recio, Eva, Camacho, Angela, Macías, Juan, Rivero, Antonio, Mira, José A, López, Cristina, Almeida, Carmen, de la Torre, Julián, Pineda, Juan A
• Format: Journal Article
• Language: English
• Published: England 01.07.2010
• Subjects: Adult; Comorbidity; Cross-Sectional Studies; Elasticity Imaging Techniques; Hepatitis C, Chronic - diagnostic imaging; HIV Infections - complications; Humans; Liver Cirrhosis - diagnostic imaging; Male; Middle Aged; Observer Variation; Prospective Studies; Triglycerides - blood
• ISSN: 1473-5687
• DOI: 10.1097/MEG.0b013e328331a5d0

Although the reproducibility of transient elastometry (TE) in hepatitis C virus (HCV)-monoinfected patients seems to be high, this may not be the case in HIV/HCV-coinfected patients because of different degrees of steatosis and/or inflammation. This study was aimed to determine the interobserver concordance of TE measurements in HIV/HCV-coinfected patients. A total of 188 patients were evaluated in a cross-sectional, prospective study in two hospitals. The interobserver variability of TE results and the rate of unequal classification of significant fibrosis (cutoff value = 7.2 kPa) and cirrhosis (cutoff value = 14.6 kPa) for two observers were evaluated. The values of liver stiffness (LS) for two observers highly correlated [intraclass correlation index = 0.976; 95% confidence interval (CI): 0.968-0.982]. The kappa indexes for the concordance of patient classification were 0.60 for significant fibrosis and 0.89 for cirrhosis. Using two cutoff points to diagnose or rule out significant fibrosis (LS >or=9 kPa or <6 kPa) yielded a kappa index of 0.96, but 46% of patients were not classified. Covariables that influenced the interobserver agreement were a high interquartile range in the determination (adjusted odd ratio: 0.189; 95% CI: 0.087-0.411; P = 0.001) and elevated levels of triglycerides (adjusted odd ratio: 1.004; 95% CI: 1.000-1.008; P = 0.031). TE measurement is an observer-independent method to evaluate LS in HIV/HCV coinfected patients. The concordance of the classification of mild-to-severe fibrosis is good and for the diagnosis of cirrhosis is excellent. Lower interquartile ranges and triglyceride levels lead to a higher interobserver agreement.