Estimating chronic hepatitis C prognosis using transient elastography‐based liver stiffness: A systematic review and meta‐analysis

摘要

Summary Chronic hepatitis C ( CHC ) is a leading cause of hepatic fibrosis and cirrhosis. The level of fibrosis is traditionally established by histology, and prognosis is estimated using fibrosis progression rates ( FPR s; annual probability of progressing across histological stages). However, newer noninvasive alternatives are quickly replacing biopsy. One alternative, transient elastography ( TE ), quantifies fibrosis by measuring liver stiffness ( LSM ). Given these developments, the purpose of this study was (i) to estimate prognosis in treatment‐na?ve CHC patients using TE ‐based liver stiffness progression rates ( LSPR ) as an alternative to FPR s and (ii) to compare consistency between LSPR s and FPR s. A systematic literature search was performed using multiple databases (January 1990 to February 2016). LSPR s were calculated using either a direct method (given the difference in serial LSM s and time elapsed) or an indirect method given a single LSM and the estimated duration of infection and pooled using random‐effects meta‐analyses. For validation purposes, FPRs were also estimated. Heterogeneity was explored by random‐effects meta‐regression. Twenty‐seven studies reporting on 39 groups of patients (N?=?5874) were identified with 35 groups allowing for indirect and 8 for direct estimation of LSPR . The majority (~58%) of patients were HIV / HCV ‐coinfected. The estimated time‐to‐cirrhosis based on TE vs biopsy was 39 and 38?years, respectively. In univariate meta‐regressions, male sex and HIV were positively and age at assessment, negatively associated with LSPR s. Noninvasive prognosis of HCV is consistent with FPR s in predicting time‐to‐cirrhosis, but more longitudinal studies of liver stiffness are needed to obtain refined estimates.