Increased liver stiffness measurement values using transient elastography in Egyptian patients with acute viral hepatitis

Transient Elastography (TE) is one of the non-invasive and reproducible tools for assessment of liver fibrosis/ cirrhosis. However, it remains to be determined if ALT flare interferes with fibrosis assessment. 1.1.Aim: To determine the effect of increased serum ALT and AST on liver stiffness measurement in patients with acute viral hepatitis. 1.2.Methods: Thirty consecutive patients with acute hepatitis of viral etiology with elevated liver enzymes (>10 folds of ULN) were prospectively included. Blood samples were collected and TE was done initially and after resolution of hepatitis and after normalization of liver enzymes. Patients with high BMI which could affect TE (> 40 kg/m2) and patients with ascites or liver cirrhosis were excluded. For determination of the etiology of hepatitis, history taking, a detailed physical examination and laboratory tests were performed in all patients. 1.3.Results: The mean age of patients was 32.87 ± 10.2 years old and males represented 46.7% (n=14). In all patients, the degree of liver stiffness at the time of the peak increase in aminotransferases exceeded the cutoff values proposed for the prediction of significant fibrosis or cirrhosis. The mean value of LSM at the time of inclusion in the study was 13.91±6.7 kPa and the mean value of LSM after resolution of hepatitis was 7.7±3.08 kPa. A progressive significant reduction in liver stiffness values was observed (P<0.01) in the follow-up period in parallel with the reduction of ALT levels (P < 0.01). Moreover, a statistically significant, positive correlation between ALT and LSM at the onset of acute viral hepatitis was found (r = 0.38, P < 0.05). No significant correlation was found between increased total bilirubin level and LSM (r= 0.3 and P > 0.05). Reduction of mean value of LSM to 6.21 ± 1.14 kPa was observed in 10 patients after 1 year of ALT normalization. 1.4.Conclusion: TE has not demonstrated reliable diagnostic accuracy in patients with acute viral hepatitis.