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Multinational collaboration establish common cut-offs for liver stiffness measurements

Finally, researchers have agreed on the interpretation of liver stiffness measurements. There has long been disagreement about which cut-off values to use for transient elastography (FibroScan). With the use of GALAXY data, a multinational collaboration has now established cut-off values to rule in and rule out compensated advanced chronic liver disease across the four major liver disease etiologies.

By Maja Thiele, , 1/25/2021

Liver stiffness measurement (FibroScan, transient elastography), is an accurate ultrasound-based technique for liver fibrosis assessment. FibroScan devices are available worldwide, and have been used to measure liver stiffness in hundreds of thousands of people since its invention in 2003. However, there have been discussion about the interpretation of liver stiffness measurements. This disagreement has resulted in several different published cut-off values. Now, a multinational collaboration with researchers from across Europe finally affirmed which cut-offs values to use for ruling out and ruling in compensated advanced chronic liver disease (cACLD), defined by presence of severe fibrosis or cirrhosis. Center for Liver Research, Odense University Hospital contributed with knowledge and data from their GALAXY cohort (GALA-ALD) of patients with alcohol related liver disease, and the study was led by researchers from University College London Institute for Liver and Digestive Health.

Using data from 5,648 patients across Europe, the research team determined that a liver stiffness below 8 kilopascal (kPa) in people with alcohol-related liver disease or non-alcoholic fatty liver (NAFLD, MAFLD) is the optimal cut-off for ruling out cACLD, while the cut-off is 7 kPa for chronic hepatitis B or C. In these cases, 93% are correctly classified. Liver stiffness measurements above 12-15 kPa are good rule-in cut-off values, but with 17-22% misclassifications (see figure below). The study is published in Journal of Hepatology: Refining the Baveno VI elastography criteria for the definition of compensated advanced chronic liver disease .

Maja Thiele, Associate Professor, Odense University Hospital

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