scholarly journals Attenuation parameter and liver stiffness measurement using FibroTouch vs Fibroscan in patients with chronic liver disease

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250300
Author(s):  
Ying Zhuang Ng ◽  
Lee Lee Lai ◽  
Sui Weng Wong ◽  
Siti Yatimah Mohamad ◽  
Kee Huat Chuah ◽  
...  
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Liver Stiffness ◽  
Chronic Liver ◽  
Healthcare Personnel ◽  
Liver Stiffness Measurement ◽  
Stiffness Measurement ◽  
Attenuation Parameter ◽  
Spearman's Rho ◽  
Examination Time

Background & aim We studied FibroTouch (FT) and Fibroscan (FS) examination results and their repeatability when performed by healthcare personnel of different background. Methods FT and FS examinations were performed on patients with chronic liver disease by two operators, a doctor and a nurse, twice on each patient, at two different time points, independent of each other. Results The data for 163 patients with 1304 examinations was analyzed. There was strong correlation between FT and FS for attenuation parameter (Spearman’s rho 0.76, p<0.001) and liver stiffness measurement (LSM) (Spearman’s rho 0.70, p<0.001). However, FT produced higher value at lower attenuation parameter and LSM, and lower value at higher attenuation parameter and LSM. There was substantial agreement when using 15kPa LSM cut-off, but only moderate agreement when using 10kPa and 20kPa LSM cut-offs and 248dB/m, 268dB/m and 280dB/m attenuation parameter cut-offs. The IQR for attenuation parameter and IQR/median for LSM were significantly lower for FT compared with FS (4dB/m vs 27dB/m, p<0.001, and 10 vs 12, p<0.001, respectively). The intra- and inter-observer reliability of attenuation parameter and LSM using FT and FS were good to excellent with intraclass correlation coefficients 0.89–0.99. FT had shorter examination time (33s vs 47s, p<0.001) and less invalid measurements (0 vs 2, p<0.001). Conclusion Measurements obtained with FT and FS strongly correlated, but significant differences in their absolute values, consistency, examination time and number of invalid measurements were observed. Either device can be used by healthcare personnel of different backgrounds when sufficiently trained.

scholarly journals Are we missing varices by implementing Baveno-VI recommendation of not screening patients with Compensated Advanced Chronic Liver Disease?

2021 ◽  
Vol 38 (1) ◽  
Author(s):  
Faiza Sadaqat Ali ◽  
Nimrah Bader ◽  
Bader Faiyaz Zuberi ◽  
Tazeen Rasheed
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Predictive Value ◽  
Operating Characteristic ◽  
Liver Stiffness ◽  
Chronic Liver ◽  
Liver Stiffness Measurement ◽  
Stiffness Measurement ◽  
Group A ◽  
Group B

Objectives: This study aimed to validate Baveno-VI recommendations for variceal screening in cACLD in our region and proposed our own cutoff values. Methods: Prospective cross-sectional study was conducted on cACLD patients from August 2020 till April 2021. Patients segregated into Group-A, having Liver stiffness measurement (LSM) of ≥ 20 kPa and platelet of ≤ 150 × 109 cells/L; and Group-B having LSM of < 20 kPa and PLT of > 150 × 109 cells/L. Gastroscopic findings were segregated into three categories, VNT, Varices Not Needing Treatment (VNNT) and No Varix (NV). ROC plots were generated for LSM and Platelet for VNT for sensitivity, specificity, Negative and Positive Predictive Values were calculated. Results: A total of 134 patients of cACLD were included. Group-A had 72 (53.7%) patients and Group-B had 62 (46.3%) patients. Group-A had 6 (8.3%) NV; 18 (25.0%) VNNT and 48 (66.7%) VNT. Group-B had 26 (41.9%) NV, 24 (38.7%) VNNT and 12 (19.4%) VNT. The sensitivity of 66.7%, specificity of 80.6% and NPV of 67.56% was obtained. Thus 19.4% VNT were missed on following Baveno VI recommendations. ROC in our study suggested cutoff value of 11.5 kPa with sensitivity of 100% and 1-sepcifity pf 78% (AUROC = 0.865; p < .001) of LSM below which screening gastroscopy could be avoided. The positive and negative predicted values for 84.85% and 100% respectively. Cut off value of platelet count for VNNT came out to be ≥ 97.5 × 109 cells/L with AUROC 0.891 (p < .001), having sensitivity of 100 % and 1-specificity of 83.3%. Conclusions: Substantial number of VNT in cACLD patients are missed by following Baveno-VI recommendations and these needs to be revised on regional basis. List If Abbreviations: AASLD: American Association for Study of Liver Diseases (AASLD), AUROC: Area Under Receiver Operating Characteristic, cACLD: Compensated Advance Chronic Liver Disease (cACLD), CTP: Child-Turcotte-Pugh, DCLD: Decompensated Chronic Liver Disease (DCLD), EV: Esophageal Varices, KPa: Kilo Pascal, LSM: Liver stiffness measurement (LSM), NPV: Negative Predictive Value, NV: No Varix (NV)., PPV: Positive Predictive Value, ROC: Receiver Operating Characteristic, VNNT: Varices Not Needing Treatment (VNNT) and VNT: Varices Needing Treatment (VNT). How to cite this:Ali FS, Bader N, Zuberi BF, Rasheed T. Are we missing varices by implementing Baveno-VI recommendation of not screening patients with Compensated Advanced Chronic Liver Disease? Pak J Med Sci. 2022;38(1):---------.  doi: https://doi.org/10.12669/pjms.38.1.4796 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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