Assessment of transient elastography in Japanese patients with non‐alcoholic fatty liver disease

Aim Transient elastography (TE) is a noninvasive method for predicting liver fibrosis. However, there is limited data regarding the performance of TE in Japanese patients with nonalcoholic fatty liver disease (NAFLD). We aimed to evaluate the association between liver stiffness measurement (LSM) by TE and liver fibrosis stage, and define a cut-off value for predicting liver fibrosis. Methods A total of 171 Japanese patients with biopsy-proven NAFLD underwent LSM using TE with FibroScan®. Area under receiver-operating characteristic curve (AUROC) of LSM and other noninvasive markers of liver fibrosis were compared to determine the most accurate method of predicting liver fibrosis. Results LSM significantly correlated with fibrosis stage (p < 0.001). The AUROCs of LSM for fibrosis stage ≥1 and ≥3 was 0.85 and 0.91, respectively and were higher than those of the AST/ALT ratio, APRI, FIB-4 index, and NAFLD fibrosis score. The best cut-off values for fibrosis stage ≥1 and ≥3 were 7.2 kPa (sensitivity 78.5%, specificity 78.3%) and 10.0 kPa (sensitivity 89.5%, specificity 87.6%), respectively. The combination of LSM (≥10kPa) and type IV collagen 7 s (≥6.0 ng/ml) had a specificity of 97.6% for advanced fibrosis. LSM in NASH of patients with high ALT levels or high BMI was associated with false positive results regarding advanced fibrosis. Conclusions In NAFLD patients, TE has excellent utility for the assessment of liver fibrosis, particularly for advanced stage cases. The cut-off value of LSM by TE for predicting liver fibrosis stage ≥3 is 10.0 kPa in Japanese NAFLD patients.