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February 15, 2021
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Transient elastography accurately screens compensated advanced chronic liver disease

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Using transient elastography within 2 months of alcohol cessation was an effective method to rule out alcohol-related compensated advanced chronic liver disease, according to study results.

Romain Moirand, MD, PhD, from the University of Rennes in France, and colleagues wrote that transient elastography (TE) has shown efficacy for assessing liver stiffness in patients with alcohol-related liver disease.

“Liver stiffness decreases rapidly in patients with alcohol withdrawal, but no prospective study as correlated histology and TE follow-up,” they wrote. “Thus, current excessive alcohol consumption seems to influence TE in ALD, and whether it is preferable to perform TE during active intoxication or to wait for abstinence is unclear.”

Researchers recruited patients who exhibited increased aspartate-amino-transferases and no history or signs of overt cirrhosis in a prospective study (n = 259). They performed TE, as histology and biochemistry within a median of 6 days after alcohol withdrawal. They also repeated TE and biochemistry at 1 and 2 months later.

Investigators found that 45 patients had compensated advanced chronic liver disease (cACLD). They used TE to accurately identify patients with cACLD at inclusion (area under the curve = 0.96; 95% CI, 0.94-0.99), 1-month follow-up (AUC = 0.96; 95% CI, 0.92-0.99) and 2-months follow-up (AUC = 0.93; 95% CI, 0.85-1).

Investigators wrote that they were able to rule out cACLD in 85% of patients when liver stiffness was less than 10 kilopascals or rule it in when it was greater than 25 kilopascals.

Among patients who had liver stiffness between 10 and 25 kilopascals at their initial measurement, more than half without cACLD had a measured liver stiffness of less than 10 kilopascals at the 1- and 2-month follow-ups.

“This study shows that 2 months from the beginning of care is a suitable period to assess fibrosis by TE in heavy drinkers identified from primary care, hepatology clinics, or addiction units,” Moirand and colleagues wrote. “Further studies are needed to determine the optimal intervals for further evaluation if patients continue excessive alcohol consumption and the possibility of a two-step strategy incorporating liver enzymes.”