Defining normal liver stiffness range in a normal healthy Chinese population without liver disease

James Fung, Cheuk-kwong Lee, Monica Chan, Wai-kay Seto, Danny Ka-ho Wong, Ching-lung Lai, Man-fung Yuen, James Fung, Cheuk-kwong Lee, Monica Chan, Wai-kay Seto, Danny Ka-ho Wong, Ching-lung Lai, Man-fung Yuen

Abstract

Background: For patients with chronic liver disease, different optimal liver stiffness cut-off values correspond to different stages of fibrosis, which are specific for the underlying liver disease and population.

Aims: To establish the normal ranges of liver stiffness in the healthy Chinese population without underlying liver disease.

Methods: This is a prospective cross sectional study of 2,528 healthy volunteers recruited from the general population and the Red Cross Transfusion Center in Hong Kong. All participants underwent a comprehensive questionnaire survey, measurement of weight, height, and blood pressure. Fasting liver function tests, glucose and cholesterol was performed. Abdominal ultrasound and transient elastography were performed on all participants.

Results: Of the 2,528 subjects, 1,998 were excluded with either abnormal liver parenchyma on ultrasound, chronic medical condition, abnormal blood tests including liver enzymes, fasting glucose, fasting cholesterol, high body mass index, high blood pressure, or invalid liver stiffness scan. The reference range for the 530 subjects without known liver disease was 2.3 to 5.9 kPa (mean 4.1, SD 0.89). The median liver stiffness was higher in males compared with females (4.3 vs 4.0 kPa respectively, p<0.001). There was also a decline in median Lliver stiffness in the older age group, from 4.2 kPa in those <25 years to 3.4 kPa for those >55 years (p=0.001).

Conclusions: The healthy reference range for liver stiffness in the Chinese population is 2.3 to 5.9 kPa. Female gender and older age group was associated with a lower median liver stiffness.

Conflict of interest statement

Competing Interests: The Hong Kong Liver Health Census was an investigator-initiated, not-for-profit study, in conjunction with the Hong Kong Liver Foundation. Financial support for provided by unrestricted grants from Bristol-Myers-Squibbs (Hong Kong), Chong Lap (Hong Kong), GlaxoSmithKline,(Hong Kong) and Novartis Pharmaceuticals (Hong Kong). Each author has declared no conflict of interest with the sponsors for this study. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1. Flow diagram of health participants…
Figure 1. Flow diagram of health participants from the Hong Kong Liver Health Census.
Figure 2. Liver stiffness according to gender.
Figure 2. Liver stiffness according to gender.
Figure 3. Liver stiffness according to different…
Figure 3. Liver stiffness according to different age groups.
Figure 4. The distribution and normal range…
Figure 4. The distribution and normal range of liver stiffness in normal subjects.

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