Vibration-controlled Transient Elastography for Assessment of Liver Fibrosis at a USA Academic Medical Center

Background and Aims:Vibration-controlled transient elastography(VCTE)is a noninvasive tool that uses liver stiffness measurement(LSM)to assess fibrosis.Since real-life data during everyday clinical practice in the USA are lacking,we describe the patterns of use and diagnostic performance of VCTE in patients at an academic medical center in New York City.Methods:Patients who received VCTE scans were included if liver biopsy was performed within 1 year.Diagnostic performance of VCTE in differentiating dichotomized fibrosis stages was assessed via area under the receiver operating characteristics(AUROC).Fibrosis stage determined from VCTE LSM was compared to liver biopsy.Results:Of 109 patients,49 had nonalcoholic fatty liver disease,16 chronic hepatitis C,15 congestive hepatopathy,and 22 at least two etiologies.AUROC was 0.90 for differentiating cirrhosis(stage 4)with a positive predictive value(PPV)range of 0.28 to 0.45 and negative predictive value range of 0.96 to 0.98.For 31(32%)patients,VCTE fibrosis stage was at least two stages higher than liver biopsy fibrosis stage.Thirteen of thirty-five pa-tients considered to have cirrhosis by VCTE had stage 0 to 2 and 12 stage 3 fibrosis on liver biopsy.Conclusions:VCTE has reasonable diagnostic accuracy and is reliable at ruling out cirrhosis.However,because of its low PPV,caution must be exercised when used to diagnose cirrhosis,as misdiagnosis can lead to unnecessary health care interventions.In routine practice,VTCE is also sometimes performed for disease etiologies for which it has not been robustly validated.

Coronavirus Disease 2019 and Liver Injury:A Retrospective Analysis of Hospitalized Patients in New York City

Background and Aims:Coronavirus disease 2019(COVID-19)is a global threat,affecting more than 100 million people and causing over 2 million deaths.Liver laboratory test abnormalities are an extrapulmonary manifestation of COVID-19,yet characterization of hepatic injury is incomplete.Our objective was to further characterize and identify causes of liver injury in patients with COVID-19.Methods:We conducted a retrospective cohort study of 551 patients hospitalized with COVID-19 at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center between March 1,2020 and May 31,2020.We analyzed patient demographics,liver laboratory test results,vital signs,other relevant test results,and clinical outcomes(mortality and intensive care unit admission).Results:Abnormal liver laboratory tests were common on hospital admission for COVID-19 and the incidence increased during hospitalization.Of those with elevated serum alanine aminotransferase and/or alkaline phosphatase activities on admission,58.2%had a cholestatic injury pattern,35.2%mixed,and 6.6%hepatocellular.Comorbid liver disease was not associated with outcome;however,abnormal direct bilirubin or albumin on admission were associated with intensive care unit stay and mortality.On average,patients who died had greater magnitudes of abnormalities in all liver laboratory tests than those who survived.Ischemic hepatitis was a mechanism of severe hepatocellular injury in some patients.Conclusions:Liver laboratory test abnormalities are common in hospitalized patients with COVID-19,and some are associated with increased odds of intensive care unit stay or death.Severe hepatocellular injury is likely attributable to secondary effects such as systemic inflammatory response syndrome,sepsis,and ischemic hepatitis.