Increase in liver stiffness measurements in severe hepatitis B flares

Abstract

BACKGROUND: Liver stiffness measurement has been used as a non-invasive technique for assessing liver fibrosis. AIM: To assess the effect of severe hepatitis B flare on liver stiffness and determine factors predictive of normal liver stiffness measurements after severe hepatitis METHODS: Patients with severe flare of hepatitis B as defined by ALT>10× upper limit of normal were included. Transient elastography was performed at time of flare (baseline), and at 3−6 months after flare. Normal liver stiffness measurement was defined as < 6kPa. Routine liver biochemistry was recorded. RESULTS: Thirty-eight patients with severe hepatitis B flare patients were included with a median age of 46 years (range, 20−73), of which 32 (84%) were male. At the time of flare, the median bilirubin, peak ALT, albumin, platelet, and prothrombin time were 41 umol/L (range, 5−778), 1543 U/L (range, 539–3000), 38 g/L (range, 23−49), 180 x 109/L (range, 47–341), and 12.9 s (10.6−24.6) respectively. The median liver stiffness was 18.5 kPa (range, 6.9−73.5), with no patients having normal liver stiffness. At 3−6 months, the median liver stiffness measurement of 8.4kPa (range, 4.4−25.1), and 10 (26%) patients had normalized their liver stiffness measurement. Thirty-six (95%) patients had a decrease in liver stiffness, with a median decline of 9.7kPa. The median ALT at 3−6 months was 31 U/L (range, 11−60), with 86% having normal ALT. Patients who had normal liver stiffness at 3−6 months had higher platelet count and lower prothrombin time at baseline compared to patients with persistently abnormal liver stiffness (230 vs 170 x 109/L, p = 0.025 and 12.2 vs 13.8 s, p = 0.034 respectively). There was significant correlation with ALT levels and liver stiffness (r = 0.64, p < 0.01). CONCLUSION: Liver stiffness was affected by severe hepatitis flares, with 95% having a decline, and over 25% normalizing their liver stiffness by 3−6 months. The significant correlation between ALT levels and liver stiffness suggests that increased liver stiffness in patients with severe flares is likely due to inflammation and not due to fibrosis. Factor associated with normalization of liver stiffness