Transient Elastography to Assess Fibrosis in Alcohol-Related Liver Disease

man drinking glass of alcohol
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A team of investigators sought to assess the effectiveness of transient elastography vs liver biopsy to rule out compensated advanced chronic liver disease in patients undergoing alcohol detoxification.

Alcohol-related compensated advanced chronic liver disease (cACLD) may be accurately assessed by transient elastography (TE) conducted during the first 2 months following alcohol cessation, according to the results of a prospective study published in Clinical Gastroenterology and Hepatology.

Patients (N=300) hospitalized for alcohol detoxification were recruited from 6 hospitals in France between 2013 and 2017. Male and female patients consumed more than 30 g/d or more than 20 g/d, respectively, of alcohol for at least 5 years and had elevated aspartate aminotransferase (AST) and g-glutamyl-transferase (gGT) concentrations. Patients underwent TE and liver biopsy and were assessed at 1-month and 2-month follow-ups.

The median age of the cohort was 45 years (interquartile range [IQR], 38-52), the male:female ratio was 207:52, 31% had steatohepatitis, 34% had ballooning hepatocytes, 29% had Mallory bodies, 69% had consumed alcohol on the day of hospital admission, and the median number of alcoholic beverages consumed per week the month prior to hospital admittance was 108 (IQR, 70-175).

Liver biopsy specimens were of a median length of 30 mm (IQR, 25-37), and 17.4% of the study participants were diagnosed with cACLD.

The participants underwent TE at a median of 6 days (IQR, 5-8) after last consumption of alcohol. TE was found to accurately predict cACLD in both the per-protocol (area under the receiving operator characteristic curve [AUC], 0.96) and intention-to-diagnose (AUC, 0.95) analyses with a rule-out cut off of less than 10 kPa and a rule-in cut-off of more than 25 kPa (specificity, 0.95; positive predictive value [PPV], 93).

These cut-off values resulted in accurate diagnoses among 84% of patients.

Among the difficult-to-diagnose patients, the presence of stage 2 to 3 perisinusoidal fibrosis differed significantly among patients with no cACLD vs those with cACLD (63% vs 17%, respectively; P =.0016). However, incorporating additional clinical parameters in an attempt to improve diagnostic precision failed to increase model accuracy.

This study may have been limited by the relatively low rate of cACLD among this patient population and may have resulted in biased cut-off rates.

The study authors concluded that TE evaluation conducted during the first few months following alcohol cessation may accurately diagnose cACLD among a majority of patients.


Legros L, Bardou-Jacquet E, Turlin B, et al. Transient elastography accurately screens for compensated advanced chronic liver disease in patients with ongoing or recent alcohol withdrawal. Clin Gastroenterol Hepatol. Published online February 12, 2021. doi:10.1016/j.cgh.2021.02.021