Alcoholic liver disease (ALD) is the most common cause of liver cirrhosis in the Western world. Systematic screening for liver fibrosis in heavy-drinking patients is a challenge. Liver biopsy is currently considered the gold standard for assessing hepatic fibrosis or cirrhosis in these patients. However, it is an invasive procedure, with rare but potentially life-threatening complications, assessing fibrosis is limited owing to sampling error. Fibroscan is a novel rapid and noninvasive method to assess liver fibrosis via liver stiffness (LS). LS was shown to be strongly associated with the degree of liver fibrosis in all of these patients.Aims
This study was to assess the accuracy of LS measurement for the diagnosis of extensive liver fibrosis in patients with ALD and to determine diagnostic LS cut-off values.Methods
93 inpatients with ALD underwent concomitant Ultrasound-Guided liver biopsy (figure 1,2,3,4) and Fibroscan (figure 5), in 103 Military Hospital from January 2016 to November 2017. Fibrosis was evaluated according to the METAVIR system as validated in ALD for fibrosis (F0: absence of fibrosis, F1: minimal portal fibrosis without septa, F2: portal fibrosis with a few septa, F3: septal fibrosis, F4: cirrhosis). LS cut-offs were determined using receiver-operating characteristic (ROC) curves.Results
Distribution in 93 patients according to the Metavir score was F1: n=13 (6.6 kPa); F2: n=24 (8.6 kPa); F3: n=31 (18.5 kPa) and F4: n=25 (40.8 kPa) (p<0.001). To diagnose liver fibrosis moderate (F≥F2): AUROC: 0.86. Threshold value is 7.9 kPa. Sensitivity (Se), specificity (Sp), (positive predictive value) PPV and negative predictive value (NPV) were 80%; 90%, 91%; and 72% for F≥F2. To diagnose liver fibrosis severity (F≥F3): AUROC: 0.91. Threshold value is 11.3 kPa. Se, Sp, PPV and NPV were 86.8%; 81%; 82%; and 85% for F≥F3.Conclusions
Fibroscan is effective to assess liver fibrosis in patients with ALD. Instant screening of liver fibrosis in heavy drinkers is feasible without liver biopsy.