Transient elastography in hepatitis C virus-infected patients with beta-thalassemia for assessment of fibrosis


  • Conflict of interest: No conflict of interest exists in relation to the submitted manuscript and there was no source of extra-institutional commercial funding.
  • An abstract of this paper was presented at Digestive Disease Week (DDW) 2012.



We sought to evaluate the performance of transient elastography (TE) for the assessment of liver fibrosis in chronic hepatitis C (CHC) patients with beta-thalassemia.


Seventy-six CHC patients with beta-thalassemia underwent TE, liver biopsy, T2-weighted magnetic resonance imaging (MRI) for the assessment of liver iron content (LIC) and laboratory evaluation. The accuracy of TE and its correlation with the other variables was assessed.


TE values increased proportional to fibrosis stage (r = 0.404, P < 0.001), but was independent of T2-weighted MRI-LIC (r = 0.064, P = 0.581). In multivariate analysis, fibrosis stage was still associated with the log-transformed TE score(standardized β = 0.42 for F4 stage of METAVIR, P = 0.001). No correlation was noted between LIC and TE score (standardized β = 0.064, P = 0.512). The area under the receiver operating characteristic curve for prediction of cirrhosis was 80% (95% confidence interval, 59–100%). A cut-off TE score of 11 had a sensitivity of 78% and specificity of 88.1% for diagnosing cirrhosis. The best cut-off values for “TE-FIB-4 cirrhosis score” comprising TE and FIB-4 and “TE-APRI cirrhosis score” combining TE with aspartate aminotransferase-to-platelet ratio index (APRI) both had 87.5% sensitivity and 91.04% specificity for the diagnosis of cirrhosis.


Regardless of LIC, TE alone or when combined with FIB-4 or APRI, is a diagnostic tool with moderate to high accuracy to evaluate liver fibrosis in CHC patients with beta-thalassemia. However, because splenectomy in a proportion of our subjects might have affected the platelet count, the scores utilizing APRI and FIB-4 should be interpreted cautiously.