Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2023; 29(39): 5503-5525
Published online Oct 21, 2023. doi: 10.3748/wjg.v29.i39.5503
Diagnostic role of transient elastography in patients with autoimmune liver diseases: A systematic review and meta-analysis
Hong Chen, Yue Shen, Sheng-Di Wu, Qin Zhu, Cheng-Zhao Weng, Jun Zhang, Mei-Xia Wang, Wei Jiang
Hong Chen, Sheng-Di Wu, Cheng-Zhao Weng, Jun Zhang, Mei-Xia Wang, Wei Jiang, Department of Gastroenterology and Hepatology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen 361015, Fujian Province, China
Hong Chen, Yue Shen, Sheng-Di Wu, Qin Zhu, Wei Jiang, Department of Gastroenterology and Hepatology, Zhongshan Hospital of Fudan University, Shanghai 200032, China
Hong Chen, Yue Shen, Sheng-Di Wu, Qin Zhu, Wei Jiang, Shanghai Institute of Liver Diseases, Fudan University Shanghai Medical College, Shanghai 200032, China
Author contributions: Jiang W conceived and designed the study; Chen H and Shen Y contributed to acquiring the data; Wang MX and Weng CZ contributed statistical analysis support; Chen H, Shen Y, Wu SD and Zhu Q contributed to analysis and interpretation of the data; Chen H wrote the manuscript; Wu SD and Zhang J contributed to manuscript revision; All authors read and approved the submitted version and are accountable for all aspects of the work.
Supported by Natural Science and Technology Major Project of Fujian Province, No. 2021D033; Natural Science Foundation of Shanghai, No. 20ZR1410900; Medical Innovation Project of Fujian Province, No. 2022CXB020; National Science and Technology Major Project, No. 2017ZX 10203202-003-002.
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Jiang, MD, PhD, Academic Research, Chief Doctor, Professor, Department of Gastroenterology and Hepatology, Zhongshan Hospital (Xiamen), Fudan University, No. 666 Jinhu Road, Huli District, Xiamen 361015, Fujian Province, China. jiang.wei@zs-hospital.sh.cn
Received: July 2, 2023
Peer-review started: July 2, 2023
First decision: August 30, 2023
Revised: September 9, 2023
Accepted: October 11, 2023
Article in press: October 11, 2023
Published online: October 21, 2023
Processing time: 109 Days and 3.6 Hours
Abstract
BACKGROUND

Noninvasive methods have been developed to detect fibrosis in many liver diseases due to the limits of liver biopsy. However, previous studies have focused primarily on chronic viral hepatitis and nonalcoholic fatty liver disease. The diagnostic value of transient elastography for autoimmune liver diseases (AILDs) is worth studying.

AIM

To compare the diagnostic accuracy of imaging techniques with serum biomarkers of fibrosis in AILD.

METHODS

The PubMed, Cochrane Library and EMBASE databases were searched. Studies evaluating the efficacy of noninvasive methods in the diagnosis of AILDs [autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC)] were included. The summary area under the receiver operating characteristic curve (AUROC), diagnostic odds ratio, sensitivity and specificity were used to assess the accuracy of these noninvasive methods for staging fibrosis.

RESULTS

A total of 60 articles were included in this study, and the number of patients with AIH, PBC and PSC was 1594, 3126 and 501, respectively. The summary AUROC of transient elastography in the diagnosis of significant fibrosis, advanced fibrosis and cirrhosis in patients with AIH were 0.84, 0.88 and 0.90, respectively, while those in patients with PBC were 0.93, 0.93 and 0.91, respectively. The AUROC of cirrhosis for patients with PSC was 0.95. However, other noninvasive indices (aspartate aminotransferase to platelet ratio index, aspartate aminotransferase/alanine aminotransferase ratio, fibrosis-4 index) had corresponding AUROCs less than 0.80.

CONCLUSION

Transient elastography exerts better diagnostic accuracy in AILD patients, especially in PBC patients. The appropriate cutoff values for staging advanced fibrosis and cirrhosis ranged from 9.6 to 10.7 and 14.4 to 16.9 KPa for PBC patients.

Keywords: Liver stiffness; Serum parameter; Liver fibrosis; Noninvasive diagnosis; Transient elastography; Autoimmune liver disease

Core Tip: Onset of autoimmune liver diseases is frequently insidious, and immune cell infiltration and continuous inflammation drive hepatic fibrosis, which gradually progresses to cirrhosis, causing poorer long-term outcomes. Liver biopsy as the reference standard is an invasive procedure. Thus, repeated biopsies are difficult to implement. Consequently, appropriate noninvasive methods are essential to dynamically monitor the degree of liver fibrosis. Our meta-analysis compared the diagnostic accuracy of imaging techniques with serum biomarkers of fibrosis in autoimmune liver diseases.