Transient Elastography in the Evaluation of Cystic Fibrosis–Associated Liver Disease: Systematic Review and Meta-analysis. Issue 2 (9th July 2018)

• Record Type: Journal Article
• Authors: Lam, Simon; Nettel-Aguirre, Alberto; Van Biervliet, Stephanie; Roeb, Elke; Sadler, Matthew D; Friedrich-Rust, Mireen; Karlas, Thomas; Kitson, Matthew T; deBruyn, Jennifer C C
• Is Part Of: Journal of the Canadian Association of Gastroenterology. Volume 2:Issue 2(2019)
• Page Start: 71
• Page End: 80
• Publication Date: 2018-07-09
• Subjects: Cystic fibrosis -- Liver disease -- Meta-analysis; Gastroenterology -- Periodicals; 616.33005
• DOI: 10.1093/jcag/gwy029
• Languages: English
• ISSNs: 2515-2084

Abstract

Abstract: Background and aims: Complications of cystic fibrosis–associated liver disease (CFLD) are a leading nonpulmonary cause of death. Transient elastography (TE) has recently been investigated to detect CFLD. This study reviews the current literature for TE in the detection CFLD. A meta-analysis was performed to determine the ideal liver stiffness measurement (LSM) cutoff. Methods: PubMed, Medline, EMBASE and Web of Science were searched from inception until April 2016 for publications involving the detection of CFLD with TE. Data were extracted using a fixed protocol (a priori design) including study design, population characteristics, probe size and AST Platelet Ratio Index (APRI). Results: Diagnostic properties were summarized from six studies of 605 patients. Cutoff for LSM was determined using pooled data submitted by authors. The cutoff for LSM and APRI were ≥5.95 kPa and ≥0.329 respectively, yielding a sensitivity, specificity and area under receiver operator characteristic of 55%, 87%, 0.76, 52%, 93% and 0.84 for LSM and APRI, respectively. When LSM ≥5.95 kPa and APRI ≥0.329, the sensitivity, specificity, positive predictive value and negative predictive value were 43%, 99%, 92% and 87% with a diagnostic odds ratio of 74.9. A bivariate metaregression model showed that pediatric specific cutoffs for liver stiffness and APRI may not be necessary. Conclusion: Individually, LSM and APRI have poor sensitivity but good specificity for detecting CFLD. They are most useful when combined. We propose that patients with LSM ≥5.95 kPa and APRI ≥0.329 be investigated thoroughly for the presence of cystic fibrosis–associated liver disease.