EASL-ALEH 2015 algorithm for the use of transient elastography in treatment-naive patients with Hepatitis B: an independent validation.

Various non-invasive methods have been evaluated in chronic hepatitis B, but none of them have been fully validated for the assessment of liver fibrosis. The issued EASL-ALEH 2015 guidelines provide detailed algorithms based on LSM and ALT serum levels. The aim of our study was to validate the diagnostic accuracy of this algorithm and to better understand discrepancies.Four hundred and thirteen patients from 3 centers were retrospectively included. All included patients were classified for fibrosis stage according to results of a liver biopsy. The overall diagnostic value was expressed with AUROCs given with 95% confidence intervals for the diagnostic targets. For each diagnostic target optimal cut-offs were determined according to the Youden method. For the population of patients with ALT N but ≤ 5N (n=306) AUROCs of transient elastography were 0.79 (0.73 - 0.84) and 0.84 (0.75 - 0.92) for F≥2, and F≥3 diagnostic targets. The prevalence of significant fibrosis was respectively 15%, 52% and 85% when LSM was less than 6kPa, between 6 and 12 kPa or greater than 12 kPa. Our study independently validates the EASL-ALEH algorithm based on ALT levels and LSM assessed by transient elastography.