Objective: Transient elastography [TE] has been validated as a non-invasive test to measure liver stiffness with high accuracy to as certain the stage of liver fibrosis. However, the liver stiffness value is confounded by food intake. Previous studies have yielded little data regarding the cutoff point for liver stiffness as measured after fasting, and there are no studies available regarding chronic hepatitis C [HCV] in Thai patients. The present study aimed to demonstrate the cutoff liver stiffness value to predict significant fibrosis (METAVIR stage >F2) using TE compared with that found through liver biopsy.

Materials and Methods: We prospectively enrolled 84 chronic HCV patients, who underwent liver biopsy to assess liver fibrosis before treatment at Srinagarind hospital from March 2016 to February 2017. On the day of the liver biopsy, liver stiffness was assessed using TE after fasting for at least three hours. Liver histology was evaluated using the METAVIR scoring system. Optimal cutoff values for liver stiffness were chosen and the area under the receiver operating characteristic curve [AUROC] was also calculated in order to identify the best cutoff values for detection of patients with METAVIR fibrosis >F2.

Results: The AUROC was 0.79 for patients with significant fibrosis (>F2). There was a cutoff value of 8.1 to detect significant fibrosis with a sensitivity, specificity, positive predictive value, and negative predictive value of 84.4%, 61.5%, 71.7%, and 77.4%, respectively. Age, sex, body mass index, history of alcohol consumption, and ALT did not significantly affect the cutoff value.

Conclusion: A liver stiffness measurement >8.1 kPa was a predictor of the significant fibrosis (F2) in Thai chronic HCV patients. This result may be useful in identifying patients for priority treatment.

Keywords: Chronic hepatitis C, Cutoff, Liver biopsy, Liver fibrosis, Transient elastography