Transient elastography in hepatitis C virus-infected patients with beta-thalassemia for assessment of fibrosis

Aim: We sought to evaluate the performance of transient elastography (TE) for the assessment of liver fibrosis in chronic hepatitis C (CHC) patients with beta-thalassemia. Methods: Seventy-six CHC patients with beta-thalassemia underwent TE, liver biopsy, T₂-weighted magnetic resonance imaging (MRI) for the assessment of liver iron content (LIC) and laboratory evaluation. The accuracy of TE and its correlation with the other variables was assessed. Results: TE values increased proportional to fibrosis stage (r=0.404, P<0.001), but was independent of T₂-weighted MRI-LIC (r=0.064, P=0.581). In multivariate analysis, fibrosis stage was still associated with the log-transformed TE score(standardized β=0.42 for F4 stage of METAVIR, P=0.001). No correlation was noted between LIC and TE score (standardized β=0.064, P=0.512). The area under the receiver operating characteristic curve for prediction of cirrhosis was 80% (95% confidence interval, 59-100%). A cut-off TE score of 11 had a sensitivity of 78% and specificity of 88.1% for diagnosing cirrhosis. The best cut-off values for "TE-FIB-4 cirrhosis score" comprising TE and FIB-4 and "TE-APRI cirrhosis score" combining TE with aspartate aminotransferase-to-platelet ratio index (APRI) both had 87.5% sensitivity and 91.04% specificity for the diagnosis of cirrhosis. Conclusion: Regardless of LIC, TE alone or when combined with FIB-4 or APRI, is a diagnostic tool with moderate to high accuracy to evaluate liver fibrosis in CHC patients with beta-thalassemia. However, because splenectomy in a proportion of our subjects might have affected the platelet count, the scores utilizing APRI and FIB-4 should be interpreted cautiously.