Validation of Transient Elastography and Comparison with Spleen Length Measurement for Staging of Fibrosis and Clinical Prognosis in Primary Sclerosing Cholangitis

Hanno Ehlken, Raluca Wroblewski, Christophe Corpechot, Lionel Arrivé, Tim Rieger, Johannes Hartl, Susanne Lezius, Peter Hübener, Kornelius Schulze, Roman Zenouzi, Marcial Sebode, Moritz Peiseler, Ulrike W Denzer, Alexander Quaas, Christina Weiler-Normann, Ansgar W Lohse, Olivier Chazouilleres, Christoph Schramm, Hanno Ehlken, Raluca Wroblewski, Christophe Corpechot, Lionel Arrivé, Tim Rieger, Johannes Hartl, Susanne Lezius, Peter Hübener, Kornelius Schulze, Roman Zenouzi, Marcial Sebode, Moritz Peiseler, Ulrike W Denzer, Alexander Quaas, Christina Weiler-Normann, Ansgar W Lohse, Olivier Chazouilleres, Christoph Schramm

Abstract

Background: Patients with primary sclerosing cholangitis (PSC) develop progressive liver fibrosis and end-stage liver disease. Non-invasive and widely available parameters are urgently needed to assess disease stage and the risk of clinical progression. Transient elastography (TE) has been reported to predict fibrosis stage and disease progression. However, these results have not been confirmed in an independent cohort and comparison of TE measurement to other non-invasive means is missing.

Methods: In a retrospective study we collected data from consecutive PSC patients receiving TE measurements from 2006 to 2014 (n = 139). Data from 62 patients who also underwent a liver biopsy were used to assess the performance of TE and spleen length (SL) measurement for the staging of liver fibrosis. Follow-up data from this cohort (n = 130, Hamburg) and another independent cohort (n = 80, Paris) was used to compare TE and SL as predictors of clinical outcome applying Harrel's C calculations.

Results: TE measurement had a very good performance for the diagnosis and exclusion of higher fibrosis stages (≥F3: AUROC 0.95) and an excellent performance for the diagnosis and exclusion of cirrhosis (F4 vs. < F4: AUROC 0.98). Single-point TE measurement had very similar predictive power for patient outcome as previously published. In a combined cohort of PSC patients (n = 210), SL measurements had a similar performance as TE for the prediction of patient outcome (5 x cross-validated Harrel's C 0.76 and 0.72 for SL and TE, respectively).

Conclusions: Baseline TE measurement has an excellent performance to diagnose higher fibrosis stages in PSC. Baseline measurements of SL and TE have similar usefulness as predictive markers for disease progression in patients with PSC.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. The Performance of TE Diagnosing…
Fig 1. The Performance of TE Diagnosing Liver Fibrosis in PSC.
Box plot of TE measurement depending on histological fibrosis stage F0-F4 (n = 62). The bottom and top of the boxes represent the 25th and 75th percentile and the horizontal lines the median. The whiskers are the minimum and maximum of the data.
Fig 2. Survival Rates of PSC Patients…
Fig 2. Survival Rates of PSC Patients for Different TE Cut-off Values.
Survival rates according to the different cut-off values (A-C) of TE measurement as previously suggested [15]. (log-rank test, p

Fig 3. Survival rates according to SL…

Fig 3. Survival rates according to SL and TE measurement.

Survival rates according to SL…

Fig 3. Survival rates according to SL and TE measurement.
Survival rates according to SL measurement with 120 mm cut-off and according to TE measurement with different cut-off values (B-D) for the combined cohort of PSC patients (Hamburg + Paris, see text). (log-rank test, p
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The study was supported by the DFG (SFB841 and KFO306), the YAEL-Foundation, and the Helmut and Hannelore Greve Foundation, Hamburg, Germany.
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Fig 3. Survival rates according to SL…
Fig 3. Survival rates according to SL and TE measurement.
Survival rates according to SL measurement with 120 mm cut-off and according to TE measurement with different cut-off values (B-D) for the combined cohort of PSC patients (Hamburg + Paris, see text). (log-rank test, p

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