New algorithm to assess fibrosis stage in alcoholic liver disease by transient elastography

Aim: Liver stiffness (LS) is the novel gold standard to assess fibrosis stage in patients with alcoholic cirrhosis (1). However, we could recently demonstrated that alcoholic steatohepatitis needs to be considered (transaminase levels) prior to fibrosis assessment since it increases LS independently of fibrosis stage. We here validate our novel algorithm (2) in a larger study population of heavy trinkers undergoing alcohol detoxification.

Methods: 155 patients admitted for alcohol detoxification were included undergoing sequential LS measurement by transient elastography and lab tests at day of admission and release. Complete data could be obtained in 120 patients. 104 patients (86%) finally fulfilled valid criteria of LS measurements (successrate >100%, IQR<30%).

Results: LS decreased in 21% by more than 30% with a mean change of LS from 11.3 to 6.6 kPa. Mean observation interval of 104 patients was 5.3 days. In 14.4% this decrease of LS changed fibrosis classification, in some cases even by two stages. In contrast, the increase of LS by >30% occurred only in 11.5% of patients leading to a change of fibrosis stage in three cases. While the increase of LS remained unclear (variability of LS, other causes, resuming alcohol consumption), the decrease of LS correlated significantly with GOT levels (signs of necroinflammation). Mean decrease of LS was 10.6% in patients with a GOT>200U/l as compared to almost no decrease (0.8%) in patients with GOT<50U/l. After detoxification, fibrosis classification via LS changed from (F0: 52–65, F1–2: 19 to 12, F3: 10 to 10, F4: 21–17.

Conclusion: This larger trial confirms our previous data: Coexisting steatohepatitis markedly increases LS in patients with ALD independent of fibrosis stage. Postponing cirrhosis assessment by FS during alcohol withdrawal until GOT decreases to <100 U/mL significantly improves the diagnostic accuracy. This consideration of transaminase levels will change fibrosis classification in ca. 15%

References: 1. Mueller S, Sandrin L. Liver stiffness: a novel parameter for the diagnosis of liver disease Hepatic Medicine: Evidence and Research 2010;2:49–67.