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VCTE staging was analysed with presence of NILF and it showed that VCTE F4 stage was associated with highest presence of NILF of 94.5% and lowest in F1 which increased sequentially from F1 to F4.
The exclusion criteria were (1) the presence of HCV or human immunodeficiency virus coinfection, (2) a positive test for anti-nuclear antibody, anti-smooth muscle antibody or anti-mitochondrial antibody, (3) a significant elevation of liver enzymes (aminotransferases > 5-fold the upper limit of normal [ULN]), and (4) an invalid VCTE result.
VCTE were performed by one experienced operator (Thanaya Techasirioangkun, RN), using a Fibroscan[R] device (Echosens, France).
Patients with significant elevation in liver enzymes (aminotransferases >5-fold the ULN) were thus excluded from the study, and VCTE was performed after the patient had fasted for at least 2 hours.
Three patients (1.3%) with invalid VCTE results and 20 patients (9.6%) with missing laboratory data were excluded.
The prevalences of liver fibrosis defined by VCTE were minimal fibrosis (F 0-1) in 74.3%, significant fibrosis (F2) in 5.34%, advanced fibrosis (F3) in 11.7%, and cirrhosis (F4) in 8.74% (Table 2).
The present study demonstrated a prevalence of liver fibrosis in Thai chronic hepatitis B patients defined by VCTE, a validated noninvasive test for assessment of liver fibrosis.
This positive finding should cause the doctor to have a low threshold for further evaluation by either VCTE or liver biopsy to define the underlying liver fibrosis status.
This is because some patients who already were diagnosed as cirrhosis by ultrasonography may not have had VCTE performed and were thus not included.
VCTE or liver biopsy should therefore be performed in these patients to evaluate the status of liver fibrosis and provide an indication for antiviral treatment to prevent the development of end-stage liver disease.
Abbreviations [alpha]SMA: Alpha smooth muscle actin ALT: Alanine aminotransferase AST: Aspartate aminotransferase APRI: Aspartate aminotransferase to platelet ratio index FHVP: Free hepatic vein pressure GGT: Gamma-glutamyl transferase HAI: Histologic activity index HCV: Hepatitis C virus HIV: Human immunodeficiency virus HVPG: Hepatic venous pressure gradient LOXL2: Lysyl oxidase-like 2 MRE: Magnetic resonance elastography NASH: Nonalcoholic steatohepatitis qRT: Quantitative real time RNA: Ribonucleic acid TGF[beta]1: Transforming growth factor beta-1 TIPS: Transjugular intrahepatic portosystemic shunt WHVP: Wedged hepatic venous pressure VCTE: Vibration-controlled transient elastography.
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