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Abstract
Aim: To determine if liver stiffness (LS) measurements by means of Transient Elastography (TE) vary according to the etiology of the underlying liver cirrhosis and to find if there are different TE cut-offvalues able to predict the presence of significant EV in alcoholic vs. viral etiology of cirrhosis. Methods: This retrospective study included patients diagnosed with liver cirrhosis of viral or alcoholic etiology. All patients were evaluated by means of TE (FibroScan) and upper gastrointestinal endoscopy. We performed 10 LS measurements in each patient and a median value expressed in kiloPascals (kPa) was calculated. Only those with a SR≥60% and an IQR<30% were considered as reliable MS measurements. According to the presence of EV the patients were divided in two categories: without significant EV and patients with significant EV (at least grade 2). Results: The study included 697 cirrhotic patients with reliable LS measurements. The median LS values assessed by TE were significantly higher in cirrhotic patients with alcoholic etiology as compared with those with viral etiology of liver disease: 41 kPa vs. 21.1 kPa, p<0.0001. In the entire cohort of cirrhotic patients, LS assessed by means of TE for a cut-offvalue >29.5 kPa, had 77.5% sensitivity and 86.9% specificity for predicting the presence of significant EV (AUROC=0.871). The best LS cut-offvalue for predicting the presence of significant EV was higher in alcoholic cirrhosis as compared with those with viral etiology of liver cirrhosis: 32.5 kPa (AUROC=0.836) vs. 24.8 kPa (AUROC=0.867). Conclusions: LS cut-offvalues assessed by TE for predicting significant EV are significantly higher in patients with alcoholic cirrhosis as compared with patients with liver cirrhosis of viral etiology.
Keywords: Transient Elastography, alcoholic liver cirrhosis, viral liver cirrhosis, esophageal varices, portal hypertension
Introduction
Chronic hepatopathies are quite common in daily clinical practice and the main etiologies of this diseases are chronic viral infections (B, C or B+D), alcoholic etiology and in lately non alcoholic fatty liver disease (NAFLD). Liver cirrhosis is the final stage of all chronic hepatopathies and it is a well known fact that cirrhosis has lots of important complications such as portal hypertension, hepatocellular carcinoma, hepatic encephalopathy, spontaneous bacterial peritonitis, hepato-renal syndrome etc.
Elastographic ultrasound-based methods such as Transient Elastography (TE) (FibroScan®) [1-3], Real- Time Tissue Elastography-Hi-RTE [4,5], Acoustic...