Increased liver stiffness in alcoholic liver disease: Differentiating fibrosis from steatohepatitis

• Published in: 世界胃肠病学杂志（英文版） Vol. 16; no. 8; pp. 966 - 972
• Main Authors: Sebastian Mueller, Gunda Millonig, Lucie Sarovska, Stefanie Friedrich, Frank M Reimann, Maria Pritsch, Silke Eisele, Felix Stickel, Thomas Longerich, Peter Schirmacher, Helmut Karl Seitz
• Format: Journal Article
• Language: English
• Published: Department of Medicine and Center for Alcohol Research, Salem Medical Center, University of Heidelberg, ZeppelinstraBe 11-33, 69121 Heidelberg, Germany%Institute of Medical Biometry and Informatics, University of Heidelberg, 69121 Heidelberg, Germany%Institute of Clinical Pharmacology, University of Bern, 3010 Bern, Switzerland%Peter Schirmacher, Department of Pathology, University of Heidelberg, 69121 Heidelberg, Germany 2010
• Subjects: Alcoholic steatohepatitis; Tissue elasticity imaging; FibroScan; Bilirubin; Liver cirrhosis; Alcoholic liver disease
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wie.vl6.i8.966

R5; AIM: To test if inflammation also interferes with liver stiffness (LS) assessment in alcoholic liver disease (ALD) and to provide a clinical algorithm for reliable fibrosis assessment in ALD by FibroScan~(R) (FS).METHODS: We first performed sequential LS analysis before and after normalization of serum transaminases in a learning cohort of 50 patients with ALD admitted for alcohol detoxification. LS decreased in almost all patients within a mean observation interval of 5.3 d. Six patients (12%) would have been misdiagnosed with F3and F4 fibrosis but LS decreased below critical cut-off values of 8 and 12.5 kPa after normalization of transaminases.RESULTS: Of the serum transaminases, the decrease in LS correlated best with the decrease in glutamic oxaloacetic transaminase (GOT). No significant changes in LS were observed below GOT levels of 100 U/L. After establishing the association between LS and GOT levels, we applied the rule of GOT < 100 U/L for reliable LS assessment in a second validation cohort of 101 patients with histologically confirmed ALD. By excluding those patients with GOT > 100 U/L at the time of LS assessment from this cohort, the area under the receiver operating characteristic (AUROC) for cirrhosis detection by FS improved from 0.921 to 0.945 while specificity increased from 80% to 90% at a sensitivity of 96%. A similar AUROC could be obtained for lower F3 fibrosis stage if LS measurements were restricted to patients with GOT < 50 U/L. Histological grading of inflammation did not further improve the diagnostic accuracy of LS.CONCLUSION: Coexisting steatohepatitis markedly increases LS in patients with ALD independent of fibrosis stage. Postponing cirrhosis assessment by FS during alcohol withdrawal until GOT decreases to < 100 U/mL significantly improves the diagnostic accuracy.