Transient elastography in autoimmune hepatitis: Timing determines the impact of inflammation and fibrosis
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Transient elastography in autoimmune hepatitis: Timing determines the impact of inflammation and fibrosis. / Hartl, Johannes; Denzer, Ulrike Walburga; Ehlken, Hanno; Zenouzi, Roman; Peiseler, Moritz; Sebode, Marcial; Hübener, Sina; Pannicke, Nadine; Weiler-Normann, Christina; Quaas, Alexander; Lohse, Ansgar W; Schramm, Christoph.
In: J HEPATOL, Vol. 65, No. 4, 01.10.2016, p. 769-75.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Transient elastography in autoimmune hepatitis: Timing determines the impact of inflammation and fibrosis
AU - Hartl, Johannes
AU - Denzer, Ulrike Walburga
AU - Ehlken, Hanno
AU - Zenouzi, Roman
AU - Peiseler, Moritz
AU - Sebode, Marcial
AU - Hübener, Sina
AU - Pannicke, Nadine
AU - Weiler-Normann, Christina
AU - Quaas, Alexander
AU - Lohse, Ansgar W
AU - Schramm, Christoph
N1 - Copyright © 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - BACKGROUND: There is an unmet need for the non-invasive monitoring of fibrosis progression in patients with autoimmune hepatitis (AIH).AIMS: To assess the diagnostic performance of transient elastography in patients with AIH and to investigate the impact of disease activity on its diagnostic accuracy.METHODS: Optimal cut-offs were defined in a prospective pilot-study (n=34) and the diagnostic performance of transient elastography validated in an independent second cohort (n=60). To explore the impact of disease activity on liver stiffness, patients were stratified according to biochemical response and the time interval between start of immunosuppression and transient elastography.RESULTS: Liver stiffness strongly correlated with histological fibrosis stage (pilot-study: ρ = 0.611, p< 0.001; validation cohort: ρ=0.777, p<0.0001). ROC curves defined an AUROC of 0.95 for diagnosing cirrhosis at the optimal cut-off of 16 kPa. The performance of transient elastography was impaired when patients were analysed in whom transient elastography was performed within 3 months from start of treatment. In this setting, liver stiffness correlated with histological grading (ρ=0.558, p=0.001), but not with staging. In contrast, using the cut-off of 16 kPa, the accuracy for diagnosing cirrhosis was excellent in patients treated for 6 months or longer (AUROC 1.0).CONCLUSIONS: Liver inflammation has a major impact on liver stiffness in the first months of AIH treatment. However, TE has an excellent diagnostic accuracy for separating severe from non-severe fibrosis after 6 months of immunosuppressive treatment.LAY SUMMARY: Transient elastography (TE) is a special ultrasound scan, which assesses liver stiffness as a surrogate marker for liver fibrosis/scarring. Transient elastography has been shown to be a reliable non-invasive method to assess liver fibrosis in various chronic liver diseases, it takes less than 5 minutes and has a high patient acceptance. The current study validated for the first time this technique in a large cohort of patients with autoimmune hepatitis (AIH) and demonstrates that it is a reliable tool to detect liver fibrosis in treated AIH. For the monitoring of potential disease progression under treatment, the validation of liver stiffness as non-invasive marker of liver fibrosis will greatly improve patient care in autoimmune hepatitis.
AB - BACKGROUND: There is an unmet need for the non-invasive monitoring of fibrosis progression in patients with autoimmune hepatitis (AIH).AIMS: To assess the diagnostic performance of transient elastography in patients with AIH and to investigate the impact of disease activity on its diagnostic accuracy.METHODS: Optimal cut-offs were defined in a prospective pilot-study (n=34) and the diagnostic performance of transient elastography validated in an independent second cohort (n=60). To explore the impact of disease activity on liver stiffness, patients were stratified according to biochemical response and the time interval between start of immunosuppression and transient elastography.RESULTS: Liver stiffness strongly correlated with histological fibrosis stage (pilot-study: ρ = 0.611, p< 0.001; validation cohort: ρ=0.777, p<0.0001). ROC curves defined an AUROC of 0.95 for diagnosing cirrhosis at the optimal cut-off of 16 kPa. The performance of transient elastography was impaired when patients were analysed in whom transient elastography was performed within 3 months from start of treatment. In this setting, liver stiffness correlated with histological grading (ρ=0.558, p=0.001), but not with staging. In contrast, using the cut-off of 16 kPa, the accuracy for diagnosing cirrhosis was excellent in patients treated for 6 months or longer (AUROC 1.0).CONCLUSIONS: Liver inflammation has a major impact on liver stiffness in the first months of AIH treatment. However, TE has an excellent diagnostic accuracy for separating severe from non-severe fibrosis after 6 months of immunosuppressive treatment.LAY SUMMARY: Transient elastography (TE) is a special ultrasound scan, which assesses liver stiffness as a surrogate marker for liver fibrosis/scarring. Transient elastography has been shown to be a reliable non-invasive method to assess liver fibrosis in various chronic liver diseases, it takes less than 5 minutes and has a high patient acceptance. The current study validated for the first time this technique in a large cohort of patients with autoimmune hepatitis (AIH) and demonstrates that it is a reliable tool to detect liver fibrosis in treated AIH. For the monitoring of potential disease progression under treatment, the validation of liver stiffness as non-invasive marker of liver fibrosis will greatly improve patient care in autoimmune hepatitis.
U2 - 10.1016/j.jhep.2016.05.023
DO - 10.1016/j.jhep.2016.05.023
M3 - SCORING: Journal article
C2 - 27238753
VL - 65
SP - 769
EP - 775
JO - J HEPATOL
JF - J HEPATOL
SN - 0168-8278
IS - 4
ER -