Transient elastography for significant fibrosis in treatment-naïve CHB patients: A systematic review and meta-analysis

Kim, Mi Na; An, Jihyun; Kim, Eun Hwa; Kim, Hee Yeon; Lee, Han Ah; Yu, Jung Hwan; Jin, Young-Joo; Chon, Young Eun; Kim, Seung Up; Jun, Dae Won; Han, Ji Won; Choi, Miyoung

doi:.0..

Original Article

Transient elastography for significant fibrosis in treatment-naïve CHB patients: A systematic review and meta-analysis

Mi Na Kim^1,2, Jihyun An³, Eun Hwa Kim⁴, Hee Yeon Kim⁵, Han Ah Lee⁶, Jung Hwan Yu⁷, Young-Joo Jin⁷, Young Eun Chon⁸, Seung Up Kim^1,2, Dae Won Jun⁹, Ji Won Han¹⁰, Miyoung Choi¹¹

¹Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
²Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
³Department of Gastroenterology and Hepatology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
⁴Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
⁵Department of Internal Medicine, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
⁶Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
⁷Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
⁸Department of Internal Medicine, Institute of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
⁹Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
¹⁰Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
¹¹Division of Health Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency (NECA), Seoul, Republic of Korea

Correspondence :

Ji Won Han ,
Email: tmznjf@catholic.ac.kr
Miyoung Choi ,
Email: mychoi@neca.re.kr

Received: May 18, 2024 Revised: July 23, 2024 Accepted: July 23, 2024
*Mi Na Kim and Jihyun An contributed equally to this work.

ABSTRACT

Background and Aims
Accurate diagnosis of significant liver fibrosis in patients with chronic hepatitis B (CHB) is crucial when determining whether to initiate antiviral treatment (AVT). We conduct a meta-analysis to assess the diagnostic performance of transient elastography (TE) for significant liver fibrosis in AVT-naïve CHB patients with serum alanine transaminase (ALT) levels within 5-fold the upper limit of normal (ULN).
Methods
The Ovid-Medline, EMBASE, Cochrane, and KoreaMed databases were searched to identify studies that compared the performance of TE and liver biopsy (reference standard) when diagnosing significant liver fibrosis (≥ F2) in AVT-naïve CHB patients with ALT within 5-fold the ULN. A hierarchical summary receiver operating characteristic curve (HSROC) and bivariate model were performed to evaluate the diagnostic performance of TE in the meta-analysis.
Results
Eight studies (2,003 patients) were included. The summary sensitivity and specificity for diagnosis of significant liver fibrosis were 0.78 [95% confidence interval (CI), 0.66–0.86] and 0.72 (95% CI, 0.60–0.82), respectively. The HSROC for the diagnosis of significant liver fibrosis was 0.81 (95% CI, 0.72–0.86). The optimal cut-off value of TE for diagnosis of significant liver fibrosis was 7.7 kPa with a sensitivity of 0.64 (95% CI, 0.50–0.76) and specificity of 0.83 (95% CI, 0.72–0.90).
Conclusions
Our study demonstrated that TE has an acceptable diagnostic performance for significant liver fibrosis in AVT-naïve CHB patients with ALT within 5-fold the ULN.

KeyWords: Chronic hepatitis B; Significant liver fibrosis; Transient elastography; antiviral treatment-naïve