Combined Serum Golgi Membrane Glycoprotein 73 Improves the Accuracy of Transient Elastography for Significant Fibrosis Detection in Patients with Chronic HBV Infections

Background: Golgi membrane glycoprotein 73 (GP73) serum level is a potential biomarker for diagnosing significant fibrosis and cirrhosis in chronic liver diseases. Objectives: The current study aimed to evaluate the accuracy of GP73 serum levels as a biomarker in the diagnosis of significant liver fibrosis in patients with hepatitis B virus (HBV). A new promising algorithm was developed by combining LSM and GP73 to predict significant liver fibrosis. Methods: Information on the following parameters were obtained from 165 patients with HBV: liver stiffness measurement (LSM), serum GP73 level, and some other fibrosis criteria approved for clinical practice. The area under the curve (AUC) and sensitivity and specificity of GP73 were compared with LSM, aminotransferase-to-platelet ratio index (APRI), and 4-factor based fibrosis index (FIB-4) for diagnosing significant fibrosis. Results: Compared to the non-significant liver fibrosis patients, the HBV infected patients with significant fibrosis showed a higher level of serum GP73 [64.05 (24.41 - 144.39) versus 91.30 (31.81 - 200.05) ng/mL, P < 0.001]. Concerning significant fibrosis diagnosis, GP73 exhibited advantages regarding the AUC (0.702), sensitivity (69.3%), and specificity (66.0%). Besides, GP73 did not show any advantage over LSM and APRI, but it had a better performance than FIB-4 in significant fibrosis detection. For the newly developed algorithm combining GP73 with LSM, the AUC, sensitivity, and specificity were 0.848, 77.4%, and 83.5%, respectively; hence, it's superior to LSM (0.832, 72.6%, and 83.5%, respectively; P = 0.016) for diagnosing significant fibrosis. Conclusions: This study demonstrated that GP73 can be considered as a new effective biomarker for diagnosing liver fibrosis. The accuracy of significant fibrosis detection in patients with HBV infection can be improved by the new algorithm that contains GP73 and LSM.

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Doppler ultrasonography combined with transient elastography improves the non-invasive assessment of fibrosis in patients with chronic liver diseases

Medical Ultrasonography ◽

10.11152/mu-921 ◽

2017 ◽

Vol 19 (1) ◽

pp. 7 ◽

Cited By ~ 2

Author(s):

Tamara Alempijevic ◽

Simon Zec ◽

Vladimir Nikolic ◽

Aleksandar Veljkovic ◽

Zoran Stojanovic ◽

...

Keyword(s):

Liver Fibrosis ◽

Hepatic Artery ◽

Sensitivity And Specificity ◽

Splenic Artery ◽

Doppler Ultrasonography ◽

Transient Elastography ◽

Liver Stiffness ◽

Significant Fibrosis ◽

Non Invasive ◽

Significant Liver Fibrosis

Aims: Accurate clinical assessment of liver fibrosis is essential and the aim of our study was to compare and combine hemodynamic Doppler ultrasonography, liver stiffness by transient elastography, and non-invasive serum biomarkers with the degree of fibrosis confirmed by liver biopsy, and thereby to determine the value of combining non-invasive method in the prediction significant liver fibrosis. Material and methods: We included 102 patients with chronic liver disease of various etiology. Each patient was evaluated using Doppler ultrasonography measurements of the velocity and flow pattern at portal trunk, hepatic and splenic artery, serum fibrosis biomarkers, and transient elastography. These parameters were then input into a multilayer perceptron artificial neural network with two hidden layers, and used to create models for predicting significant fibrosis. Results: According to METAVIR score, clinically significant fibrosis (≥F2) was detected in 57.8% of patients. A model based only on Doppler parameters (hepatic artery diameter, hepatic artery systolic and diastolic velocity, splenic artery systolic velocity and splenic artery Resistance Index), predicted significant liver fibrosis with a sensitivity and specificity of75.0% and 60.0%. The addition of unrelated non-invasive tests improved the diagnostic accuracy of Doppler examination. The best model for prediction of significant fibrosis was obtained by combining Doppler parameters, non-invasive markers (APRI, ASPRI, and FIB-4) and transient elastography, with a sensitivity and specificity of 88.9% and 100%. Conclusion: Doppler parameters alone predict the presence of ≥F2 fibrosis with fair accuracy. Better prediction rates are achieved by combining Doppler variables with non-invasive markers and liver stiffness by transient elastography.

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Liver Fibrosis Assessment in a Cohort of Greek HIV Mono-Infected Patients by Non-Invasive Biomarkers

Current HIV Research ◽

10.2174/1570162x17666190809153245 ◽

2019 ◽

Vol 17 (3) ◽

pp. 173-182

Author(s):

Theodoros Androutsakos ◽

Maria Schina ◽

Abraham Pouliakis ◽

Athanasios Kontos ◽

Nikolaos Sipsas ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Sensitivity And Specificity ◽

Transient Elastography ◽

Standard Procedure ◽

Liver Stiffness ◽

Alcoholic Fatty Liver ◽

Non Invasive ◽

Metavir Score ◽

Significant Liver Fibrosis

Background: Non-alcoholic Fatty Liver Disease (NAFLD) is common in HIV-infected individuals. Liver biopsy remains the gold-standard procedure for the diagnosis of liver fibrosis, but both Transient Elastography (TE) and Non-invasive Biomarkers (NIBMs) have emerged as alternatives. Objectives: Our study’s aim was to validate commonly used NIBMs for the assessment of liver fibrosis in a cohort of Greek HIV-mono-infected patients. Methods: Inclusion criteria were confirmed HIV-infection and age>18 years and exclusion criteria HBV or HCV seropositivity, liver disease other than NAFLD, alcohol abuse, ascites, transaminases levels>4xULN(upper limit of normal) and Body-Mass index(BMI)>40. Liver stiffness (LS) measurement with TE and thorough laboratory work up and medical history were acquired at study entry. FIB-4, APRI, NFS, BARD, Forns and Lok scores were calculated for each patient. Results: A total of 157 patients were eligible for this study. Significant liver fibrosis, compatible with Metavir score of F3-F4, was found in only 11(7%) patients. These findings were in accordance with those of the NIBMs; the BARD score constituting the only exception, allocating 102(65%) patients as having significant liver fibrosis. In order to obtain a balance between sensitivity and specificity new cut-offs for each NIBM were calculated; FIB-4 score yielded the best results, since by changing the cut-off to 1.49 a sensitivity and specificity balanced for both close to 85% was achieved. Conclusions: Our findings suggest that NIBMs can be used for the evaluation of liver fibrosis in HIV mono-infected patients. New cut-offs for NIBMs should probably be calculated, to help distinguishing patients with significant from those with mild/no fibrosis.

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Association of Magnesium Intake with Liver Fibrosis among Adults in the United States

Nutrients ◽

10.3390/nu13010142 ◽

2021 ◽

Vol 13 (1) ◽

pp. 142

Author(s):

Meng-Hua Tao ◽

Kimberly G. Fulda

Keyword(s):

Liver Fibrosis ◽

Calcium Intake ◽

Magnesium Deficiency ◽

Transient Elastography ◽

Liver Stiffness ◽

The United States ◽

Inverse Association ◽

Significant Fibrosis ◽

Magnesium Intake ◽

Total Magnesium

Liver fibrosis represents the consequences of chronic liver injury. Individuals with alcoholic or nonalcoholic liver diseases are at high risk of magnesium deficiency. This study aimed to evaluate the association between magnesium and calcium intakes and significant liver fibrosis, and whether the associations differ by alcohol drinking status. Based on the National Health and Nutrition Examination Survey (NHANES) 2017–2018, the study included 4166 participants aged >18 years who completed the transient elastography examination and had data available on magnesium intake. The median liver stiffness of 8.2 kPa was used to identify subjects with significant fibrosis (≥F2). The age-adjusted prevalence of significant fibrosis was 12.81%. Overall total magnesium intake was marginally associated with reduced odds of significant fibrosis (p trend = 0.14). The inverse association of total magnesium intake with significant fibrosis was primarily presented among those who had daily calcium intake <1200 mg. There were no clear associations for significant fibrosis with calcium intake. Findings suggest that high total magnesium alone may reduce risk of significant fibrosis. Further studies are needed to confirm these findings.

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One-Year Outcomes after Ledipasvir/Sofosbuvir Treatment of Chronic Hepatitis C in Teenagers with and without Significant Liver Fibrosis—A Case Series Report

Viruses ◽

10.3390/v13081518 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1518

Author(s):

Maria Pokorska-Śpiewak ◽

Anna Dobrzeniecka ◽

Magdalena Marczyńska

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Liver Fibrosis ◽

Chronic Hepatitis C ◽

Liver Stiffness ◽

Case Series ◽

Significant Fibrosis ◽

End Of Treatment ◽

One Year ◽

Significant Liver Fibrosis

One-year outcomes after therapy with ledipasvir/sofosbuvir (LDV/SOF) in children with chronic hepatitis C (CHC) presenting with and without significant liver fibrosis were analyzed. We included patients aged 12–17 years treated with LDV/SOF, presenting with significant fibrosis (F ≥ 2 on the METAVIR scale) in transient elastography (TE) at the baseline and we compared the outcomes with that of patients without fibrosis. Patients were followed every 4 weeks during the treatment, at the end of the therapy, at week 12 posttreatment, and one year after the end of treatment. Liver fibrosis was established using noninvasive methods: TE, aspartate transaminase-to-platelet ratio index (APRI), and Fibrosis-4 index (FIB-4). There were four patients with significant fibrosis at baseline: one with a fibrosis score of F2 on the METAVIR scale, and three with cirrhosis (F4) at baseline. One year after the end of treatment, the hepatitis C viral load was undetectable in three of them. One patient was lost to follow-up after week 4. In two out of the four patients, a significant improvement and regression of liver fibrosis was observed (from stage F4 and F2 to F0-F1 on the METAVIR scale). In one patient, the liver stiffness measurement median increased 12 weeks after the end of the treatment and then decreased, but still correlated with stage F4. An improvement in the APRI was observed in all patients. In four patients without fibrosis, the treatment was effective and no progression of fibrosis was observed. A one-year observation of teenagers with CHC and significant fibrosis treated with LDV/SOF revealed that regression of liver fibrosis is possible, but not certain. Further observations in larger groups of patients are necessary to find predictors of liver fibrosis regression.

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Liver Stiffness Measurement in Psoriasis: Do Metabolic or Disease Factors Play the Important Role?

BioMed Research International ◽

10.1155/2016/7963972 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Jamrus Pongpit ◽

Saneerat Porntharukchareon ◽

Piyaporn Kaewduang ◽

Kwannapa Promson ◽

Wasana Stitchantrakul ◽

...

Keyword(s):

Metabolic Syndrome ◽

Waist Circumference ◽

Liver Fibrosis ◽

Associated Factors ◽

Transient Elastography ◽

Liver Stiffness ◽

Liver Stiffness Measurement ◽

Nonalcoholic Fatty Liver ◽

Stiffness Measurement ◽

Significant Liver Fibrosis

Background. An increased prevalence of metabolic syndrome including nonalcoholic fatty liver disease (NAFLD) was reported in psoriasis. NAFLD can progress to nonalcoholic steatohepatitis and fibrosis. Transient elastography (TE) is a noninvasive liver fibrosis assessment. We evaluated the prevalence of significant liver fibrosis or high liver stiffness measurement (LSM) using the LSM cutoff over 7 kPa and its associated factors in psoriatic patients. Methods. Subjects underwent TE and ultrasonography. Univariate and multivariate analysis were performed for the associated factors. Results. One hundred and sixty-eight patients were recruited. Three patients were excluded due to TE failure. Mean BMI was 24.8±4.7 kg/m2. NAFLD, metabolic syndrome, and diabetes were seen in 105 (63.6%), 83 (50.3%), and 31 (18.8%) patients. The total cumulative dose of methotrexate over 1.5 g was seen in 39 (23.6%) patients. Mean LSM was 5.3±2.9 kPa. High LSM was found in 18 (11.0%) patients. Waist circumference (OR: 1.24; 95% CI: 1.11–1.38; P=0.0002), diabetes (OR: 12.70; 95% CI: 1.84–87.70; P=0.010), and AST (OR: 1.08; 95% CI: 1.02–1.16; P=0.017) were associated with high LSM. Conclusion. 11% of psoriatic patients had significant liver fibrosis by high LSM. Waist circumference, diabetes, and AST level were the independent predictors.

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The Diagnostic Accuracy of LOGIQ S8 and E9 Shear Wave Elastography for Staging Hepatic Fibrosis, in Comparison with Transient Elastography

Diagnostics ◽

10.3390/diagnostics11101817 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1817

Author(s):

Jeong-Ju Yoo ◽

Sang Gyune Kim ◽

Young Seok Kim

Keyword(s):

Liver Cirrhosis ◽

Liver Disease ◽

Liver Fibrosis ◽

Chronic Liver Disease ◽

Shear Wave ◽

Transient Elastography ◽

Liver Stiffness ◽

Shear Wave Elastography ◽

Chronic Liver ◽

Significant Fibrosis

Background: The aim of this study was to evaluate the usefulness of two different types of 2-dimensional shear wave elastography (2D-SWE) for predicting liver fibrosis stages in comparison to transient elastography (TE), using a histologic METAVIR scoring system as the reference method. Methods: A total of 203 patients with chronic liver disease were prospectively enrolled in the study. Two different 2D-SWEs (LOGIQ S8 and E9 systems, GE Healthcare, Chalfont St Giles, UK) were assessed for liver stiffness in patients with chronic liver diseases. Patients received 2D-SWE examinations with the S8 and E9 systems, and also underwent TE (FibroScan®, Echosens, France) tests and liver biopsies on the same day. Results: The most common etiology of chronic liver disease was non-alcoholic fatty liver disease (28.7%), followed by chronic hepatitis B (25.1%). Liver fibrosis stages consisted of F0 (22.6%), F1 (29.7%), F2 (16.9%), F3 (12.8%) and F4 (17.9%). Overall, S8 and E9 were well correlated with the histologic fibrosis stages. The optimal cut-off values for S8 and E9 to differentiate significant fibrosis (≥F2) were 6.70 kPa and 6.42 kPa, respectively, while the cut-off values for S8 and E9 in distinguishing liver cirrhosis were 9.15 kPa and 8.88 kPa, respectively. Among the 195 patients who had successful measurements in both S8 and E9, liver stiffness showed good inter-equipment correlation (ICC: 0.900, p < 0.001). Regarding diagnostic ability, upon comparison (FibroScan®), there were no significant differences between 2D-SWEs and TE for detecting every stage of liver fibrosis. Conclusion: In comparison to TE, 2D-SWE with LOGIQ S8 and E9 (GE Healthcare) are useful non-invasive tools for predicting significant fibrosis and liver cirrhosis.

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Utility of Transient Elastography for the Screening of Liver Disease in Patients with Alpha1-Antitrypsin Deficiency

Journal of Clinical Medicine ◽

10.3390/jcm10081724 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1724

Author(s):

Mònica Pons ◽

Alexa Núñez ◽

Cristina Esquinas ◽

María Torres-Durán ◽

Juan Luis Rodríguez-Hermosa ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Liver Enzymes ◽

Transient Elastography ◽

Liver Stiffness ◽

Normal Liver ◽

Cross Sectional ◽

Elevated Liver Enzymes ◽

Antitrypsin Deficiency ◽

Significant Liver Fibrosis

Screening of liver disease in alpha-1 antitrypsin deficiency (AATD) is usually carried out with liver enzymes, with low sensitivity. We conducted a multicenter cross-sectional study aiming to describe the utility of transient elastography for the identification of liver disease in patients with AATD. A total of 148 AATD patients were included. Among these, 54.7% were Pi*ZZ and 45.3% were heterozygous for the Z allele. Between 4.9% and 16.5% of patients had abnormal liver enzymes, without differences among genotypes. Liver stiffness measurement (LSM) was significantly higher in Pi*ZZ individuals than in heterozygous Z (5.6 vs. 4.6 kPa; p = 0.001). In total, in 8 (5%) individuals LSM was >7.5 kPa, considered significant liver fibrosis, and ≥10 kPa in 3 (1.9%) all being Pi*ZZ. Elevated liver enzymes were more frequently observed in patients with LSM > 7.5 kPa, but in 5 out of 8 of these patients all liver enzymes were within normal range. In patients with AATD, the presence of abnormal liver enzymes is frequent; however, most of these patients do not present significant liver fibrosis. Transient elastography can help to identify patients with liver fibrosis even with normal liver enzymes and should be performed in all Z-allele carriers to screen for liver disease.

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Prevalence and Determinants of Significant Liver Fibrosis by Vibration-Controlled Transient Elastography in Thai Chronic Hepatitis B Patients

International Journal of Hepatology ◽

10.1155/2018/4310102 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Apichet Sirinawasatien ◽

Thanaya Techasirioangkun ◽

Siriporn Thongsri

Keyword(s):

Chronic Hepatitis ◽

Hepatitis B Virus ◽

Liver Fibrosis ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Transient Elastography ◽

Male Gender ◽

Significant Fibrosis ◽

B Virus ◽

Significant Liver Fibrosis

Aims. To describe the prevalence of significant liver fibrosis by ultrasound-based vibration-controlled transient elastography (VCTE; FibroScan®) and to identify the determinants of significant liver fibrosis in Thai chronic hepatitis B patients. Methods. A cross-sectional study of consecutive chronic hepatitis B patients performed VCTE and followed up at Rajavithi Hospital, Bangkok, Thailand, was conducted between 1 January, 2013, and 31 December, 2016. Liver fibrosis was defined as minimal (METAVIR F0-1) by VCTE < 7.2 kPa and significant (METAVIR F2-4) by VCTE ≥ 7.2 kPa. VCTE assessments and medical records were retrospectively reviewed. The prevalence and determinants of significant liver fibrosis were analyzed. Results. A total of 206 eligible patients were included; 120 patients (58.3%) were female. The mean age was 50 years (SD 12.4 years), and 32.5% had a body mass index ≥ 25. The prevalences of minimal (F 0-1) and significant fibrosis (F2-4) were 74.3% and 25.7%, respectively. The prevalence of hepatitis B e antigen negative (HBeAg -ve) was 83%. The median serum hepatitis B virus viral load was 4,340 IU/mL (range 20-271,883,036). Significant determinants of significant fibrosis (F2-4) were male gender (aOR 3.24 [95%CI: 1.36-7.72]) and high aspartate transaminase (AST) level (aOR 5.71 [95%CI: 2.03-16.04]). Conclusion. Around one-quarter of the Thai patients with chronic viral hepatitis B had significant liver disease defined by VCTE, requiring further evaluation for specific treatment for hepatitis B virus. Determinants of significant liver fibrosis were male gender and high AST level.

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Early kidney dysfunction in non-alcoholic fatty liver disease - is transient elastography useful as a screening method?

Digestive Diseases ◽

10.1159/000514811 ◽

2021 ◽

Author(s):

Marta Freitas ◽

Vítor Macedo Silva ◽

Sofia Xavier ◽

Joana Magalhes ◽

Carla Marinho ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Transient Elastography ◽

Screening Method ◽

Kidney Dysfunction ◽

Alcoholic Fatty Liver ◽

Increased Risk ◽

Significant Liver Fibrosis

Introduction: Increasing evidence suggests an association between metabolic associated fatty liver disease (MAFLD) and chronic kidney disease (CKD). Timely prediction of early kidney dysfunction (EKD) is thus essential in this population, although a screening method is not stablished. We aimed to evaluate the role of transient elastography (TE) in predicting EKD in patients with MAFLD. Methods: Prospective cohort study that included patients with MAFLD scheduled for evaluation, between May/2019 and January/2020. Demographic, clinical and laboratory data, and TE parameters were obtained. EKD was defined as microalbuminuria (urinary albumin-to-creatinine ratio 30-300mg/g) and estimated glomerular filtration rate≥60mL/min/1.73m2. Significant liver fibrosis was defined as liver stiffness measurement (LSM)≥8.2kPa. Results: Included 45 patients with MALFD, 53.3% female gender, mean age of 53.5±10.9years. EKD was found in 17.8% of patients. MAFLD patients with EKD were significantly more obese (body mass index≥30) (75.0% vs 32.4%,p=0.045) and had significantly higher LSM (8.5±4.1 vs 5.8±2.2kPa,p=0.01). After adjustment of potential confounders for EKD the presence of liver fibrosis, remained a significant predictor of EKD, being associated with a 14.3-fold increased risk of EKD (p=0.04). The optimal cutoff value of LSM to predict EKD was 6.1kPa (sensitivity:85.7%; specificity:67.6%). Conclusion: Significant liver fibrosis is associated with a significant increased risk of EKD in patients with MAFLD, regardless of other comorbidities. Higher levels of LSM, particularly >6.1kPa, alert for timely identification of EKD and associated comorbidities, as well as their control, in order to prevent the development of CKD in the long term.

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FRI0118 RISK OF LIVER FIBROSIS ON TRANSIENT ELASTOGRAPHY IN PATIENTS WITH RHEUMATIC DISEASE UNDER LONG-TERM METHOTREXATE TREATMENT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3553 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 640.1-640

Author(s):

S. J. Choi ◽

J. S. Lee ◽

S. H. Nam ◽

W. J. Seo ◽

J. S. Oh ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Autoimmune Disease ◽

Liver Fibrosis ◽

Rheumatic Disease ◽

Logistic Regression Analysis ◽

Takayasu Arteritis ◽

Transient Elastography ◽

Liver Stiffness

Background:Methotrexate (MTX) is a cornerstone drug for the treatment of rheumatic disease and low doses of MTX are both tolerable and safe, with monitored toxicity, assessed via the liver function test. However, there is still controversy regarding the risk of liver fibrosis with long-term use of MTX. Transient elastography is commonly used to assess and monitor fibrosis progression in patients with chronic liver disease.Objectives:The present study aims to investigate liver fibrosis using transient elastography and related factors in patients with rheumatic disease receiving long-term MTX.Methods:The present retrospective, longitudinal, cross-sectional study included patients with an autoimmune disease who are taking cumulative MTX dosed over 7 g, and who had liver fibrosis upon examination using transient elastography. Liver fibrosis was defined as liver stiffness, valued over 7.2 kPa. Logistic regression analysis was performed to identify factors associated with liver fibrosis, and receiver operating characteristics analysis was used to determine the predictive value of each factor.Results:We included 83 patients with autoimmune disease, with a median MTX cumulative dose of 11.6 (range 7.3-16.0) g. Sixty-eight patients (81.9%) had rheumatoid arthritis (RA), and 13 patients (15.7%) had Takayasu arteritis. The median MTX exposure duration was 18 (range 9-31) years. The median liver stiffness value was 4 (range 1.8-10.2) kPa. Five patients (6%) showed liver fibrosis (3 patients; RA, 2 patients; Takayasu arteritis). In the linear regression analysis, cumulative MTX dose showed a tendency towards a positive correlation with increasing liver stiffness value (r2 =0.039, p = 0.074). In the logistic regression analysis, cumulative MTX dose was associated with a higher risk of liver fibrosis (OR: 1.734, 95% CI: 1.060–2.837, p = 0.029). In addition, cumulative MTX dose had an area under the curve (AUC) of 0.813 (95% CI 0.695-0.930) and a sensitivity of 80% and specificity of 71.8% at a cut-off value of 12.7 g.Conclusion:Liver fibrosis was observed in 6% of patients with long-term MTX use and higher cumulative MTX doses increased the risk of liver fibrosis. Thus, transient elastography should be considered in patients exposed to high cumulative doses of MTX.Disclosure of Interests:None declared

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