Transient elastography is yet to be recognized as the non-invasive diagnosis of alcohol-related liver fibrosis. an individual patient data (IPD) meta-analysis determined the specific diagnostic cutoff values for liver stiffness in alcohol-related fibrosis and evaluated the effect of aminotransferase concentrations, bilirubin concentrations, and presence of asymptomatic and non-severe alcoholic hepatitis on liver stiffness.

Literature was searched to determine the diagnostic cutoffs for alcohol-induced liver fibrosis considering the FibroScan results. Random-effects meta-analysis evaluated the diagnostic cutoffs for the various fibrosis stages and the effects of aspartate aminotransferase (AST) concentrations, bilirubin concentrations, and histological features of asymptomatic and non-severe alcoholic hepatitis on liver stiffness cutoff.

The following observations were made-

• 10 studies including 1026 patients underwent the meta-analysis.
• Liver stiffness cutoffs were found to be 7·0 kPa for F≥1 fibrosis, 9·0 kPa for F≥2, 12·1 kPa for F≥3, and 18·6 kPa for F=4. 
• AST and Bilirubin concentrations were found to be related to liver stiffness, with higher concentrations associated with higher liver stiffness values, and with marked higher cutoff values for diagnosis of all fibrosis stages except F≥1. 
• The existence of histological characteristics of asymptomatic and non-severe alcoholic hepatitis caused increased liver stiffness. 
• Multivariate analysis showed AST and bilirubin concentrations, and prothrombin activity to be independently linked with the presence of histological features of asymptomatic and non-severe alcoholic hepatitis. 
• Furthermore, specific liver stiffness cutoffs were specified based on concentrations of AST and bilirubin. 
• Liver stiffness cutoff values were found to be directly proportional to AST concentrations, bilirubin concentrations, or both.

Thus the association between liver stiffness and the histological features of asymptomatic and non-severe alcoholic hepatitis, imaged by AST and bilirubin concentrations were explained in this study. In alcohol-related liver disease, FibroScan assessments of liver fibrosis should include AST and bilirubin concentrations by utilizing specifically adjusted liver stiffness cutoffs.

Source- Nguyen-Khac E, Thiele M, Voican C, Nahon P, Moreno C, Boursier J et al. Non-invasive diagnosis of liver fibrosis in patients with alcohol-related liver disease by transient elastography: an individual patient data meta-analysis, The Lancet Gastroenterology & Hepatology,2018;3(9):614-625. https://doi.org/10.1016/S2468-1253(18)30124-9.