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:
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.
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
Research background

Noninvasive criteria are needed for autoimmune liver diseases (AILDs) to assess liver fibrosis stage for prognosis and treatment decisions.

Research motivation

Results of individual diagnostic test accuracy studies assessing the diagnostic accuracy of transient elastography (TE) for the diagnosis of AILD appear promising. However, previous systematic review and meta-analyses have focused primarily on other liver diseases, which is still lacking in AILD.

Research objectives

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

Research methods

The PubMed, Cochrane and EMBASE databases were searched for literature. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to evaluate the quality. Meta-Disc 1.4 and STATA 12.0 software were used to analyze the combined statistics: sensitivity; specificity; positive likelihood ratio; negative likelihood ratio; diagnostic odds ratio; and area under the curve fitted to the total receiver operating characteristic curve (AUROC).

Research results

A total of 60 studies were included in the meta-analysis. The AUROC curve values were 0.93, 0.93 and 0.91 for significant fibrosis, advanced fibrosis and cirrhosis, respectively, in primary biliary cholangitis patients, while the AUROC curve values were 0.84, 0.88 and 0.90, respectively, in autoimmune hepatitis patients.

Research conclusions

TE is a reliable method for diagnosis in AILD patients, especially in primary biliary cholangitis patients. The appropriate cutoff value for staging advanced fibrosis and cirrhosis ranged from 9.6 to 10.7 KPa and 14.4 to 16.9 KPa, respectively.

Research perspectives

We propose a suitable diagnostic threshold for TE in PBC patients. However, future prospective multicenter studies with TE and histopathology protocol are required to validate our results.