1. Refining the Baveno VI elastography criteria for the definition of compensated advanced chronic liver disease
- Author
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Sebastian Mueller, Paul Calès, Omar Elshaarawy, Jérôme Boursier, Emmanuel Tsochatzis, Aleksander Krag, Umberto Arena, Victor de Ledinghen, Margarita Papatheodoridi, Maja Thiele, Massimo Pinzani, Laurent Castera, Edgar Brodkin, George V. Papatheodoridis, Fabio Marra, Georgios Markakis, Jean Baptiste Hiriart, Monica Lupsor-Platon, Audrey Payancé, Vincenza Calvaruso, Fabrizio Bronte, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Università degli Studi di Firenze = University of Florence [Firenze] (UNIFI), Papatheodoridi M., Hiriart J.B., Lupsor-Platon M., Bronte F., Boursier J., Elshaarawy O., Marra F., Thiele M., Markakis G., Payance A., Brodkin E., Castera L., Papatheodoridis G., Krag A., Arena U., Mueller S., Cales P., Calvaruso V., de Ledinghen V., Pinzani M., and Tsochatzis E.A.
- Subjects
0301 basic medicine ,Alcoholic liver disease ,medicine.medical_specialty ,Cirrhosis ,[SDV]Life Sciences [q-bio] ,Chronic liver disease ,Asymptomatic ,Gastroenterology ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Internal medicine ,NAFLD ,medicine ,Viral hepatitis ,10. No inequality ,Portal hypertension ,ComputingMilieux_MISCELLANEOUS ,Cirrhosi ,Hepatology ,medicine.diagnostic_test ,business.industry ,Fatty liver ,medicine.disease ,3. Good health ,030104 developmental biology ,Fibroscan ,Liver biopsy ,FIB-4 ,030211 gastroenterology & hepatology ,medicine.symptom ,Transient elastography ,business - Abstract
Background: The Baveno VI consensus proposed a dual liver stiffness (LS) by transient elastography threshold of 15 kPa for excluding and diagnosing compensated advanced chronic liver disease (cACLD) in the absence of other clinical signs. Herein, we aimed to validate these criteria in a real-world multicentre study. Methods: We included 5,648 patients (mean age 51 ± 13 years, 53% males) from 10 European liver centres who had a liver biopsy and LS measurement within 6 months. We included patients with chronic hepatitis C (n = 2,913, 52%), non-alcoholic fatty liver disease (NAFLD, n = 1,073, 19%), alcohol-related liver disease (ALD, n = 946, 17%) or chronic hepatitis B (n = 716, 13%). cACLD was defined as fibrosis stage ≥F3. Results: Overall, 3,606 (66%) and 987 (18%) patients had LS 15 kPa, respectively, while cACLD was histologically confirmed in 1,772 (31%) patients. The cut-offs of 15 kPa showed 75% sensitivity and 96% specificity to exclude and diagnose cACLD, respectively. Examining the ROC curve, a more optimal dual cut-off at 12 kPa, with 91% sensitivity and 92% specificity for excluding and diagnosing cACLD (AUC 0.87; 95% CI 0.86–0.88; p 15 kPa dual cut-offs, we found that the 12 kPa dual cut-offs have better diagnostic accuracy in cACLD. Lay summary: The term compensated advanced chronic liver disease (cACLD) was introduced in 2015 to describe the spectrum of advanced fibrosis and cirrhosis in asymptomatic patients. It was also suggested that cACLD could be diagnosed or ruled out based on specific liver stiffness values, which can be non-invasively measured by transient elastography. Herein, we assessed the suggested cut-off values and identified alternative values that offered better overall accuracy for diagnosing or ruling out cACLD.
- Published
- 2021
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