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World J Meta-Anal. Dec 18, 2023; 11(7): 340-350
Published online Dec 18, 2023. doi: 10.13105/wjma.v11.i7.340
Transient elastography (FibroScan) in critical care: Applications and limitations
Sahil Kataria, Deven Juneja, Omender Singh
Sahil Kataria, Department of Critical Care Medicine, Holy Family Hospital, New Delhi 110025, India
Deven Juneja, Omender Singh, Department of Critical Care Medicine, Max Super Speciality Hospital, New Delhi 110017, India
Author contributions: Kataria S and Juneja D researched the subject, performed data accusation, and performed the majority of the writing; Singh O provided inputs in paper writing and reviewed the final draft.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Deven Juneja, DNB, MBBS, Director, Department of Critical Care Medicine, Max Super Speciality Hospital, 1 Press Enclave Road, Saket, New Delhi 110017, India. devenjuneja@gmail.com
Received: July 28, 2023
Peer-review started: July 28, 2023
First decision: August 10, 2023
Revised: August 28, 2023
Accepted: September 22, 2023
Article in press: September 22, 2023
Published online: December 18, 2023
Processing time: 138 Days and 14.9 Hours
Abstract

FibroScan® is a non-invasive device that assesses the ‘hardness’ (or stiffness) of the liver via the technique of transient elastography. Because fibrous tissue is harder than normal liver, the degree of hepatic fibrosis can be inferred from the liver hardness. This technique is increasingly being employed to diagnose liver fibrosis, even in critically ill patients. It is now being used not only for diagnosis and staging of liver cirrhosis, but also for outcome prognostication. However, the presence of several confounding factors, especially in critically ill patients, may make interpretation of these results unreliable. Through this review we aim to describe the indications and pitfalls of employing FibroScan in patients admitted to intensive care units.

Keywords: FibroScan; Intensive care unit; Liver dysfunction; Liver stiffness; Transient elastography

Core Tip: Liver dysfunction is common in critically ill patients. For diagnosis, severity assessment, and prognostication of liver fibrosis, liver biopsy is considered the gold standard. However, because of inherent risks associated with the invasive nature of liver biopsy, non-invasive tests may be preferable in intensive care unit patients. Serology markers for liver fibrosis lack specificity and accuracy and hence newer tests like liver stiffness measurement (LSM) are increasingly been used in these patients. Transient elastography using FibroScan is arguably the most commonly employed and validated tool for LSM. FibroScan has been used in the management, prediction of complications, and prognostication of various liver diseases including acute and chronic conditions. However, there are several integral limitations which should be considered while applying this test in critically ill patients.