Liver stiffness measurement using FibroScan ® is influenced by serum total bilirubin in acute hepatitis

Background: Liver stiffness measurement (LSM) using FibroScan ® is accepted as a highly reproducible and accurate technique for assessment of liver fibrosis. However, several studies have indicated that the LSM value can be significantly influenced by major changes in aminotransferases in patients with chronic viral hepatitis and LSM is unreliable for diagnosing underlying liver cirrhosis in patients with acute liver damage. We aimed to determine biochemical factors influencing the LSM value in patients with acute hepatitis. Methods: From July to December 2007, a total of 60 patients with acute hepatitis of varying aetiologies were recruited prospectively. LSM and biochemical tests were performed at diagnosis and recovery from acute hepatitis. Results: The mean age of the patients (38 men and 22 women) was 40.7 ± 15.4 years. The aetiology of acute hepatitis included hepatitis A virus in 31 patients, drug induced in 19 and hepatitis B virus in 10. The mean LSM value was 19.6 kPa at diagnosis and 15.9 kPa at recovery. Correlation analysis showed that the LSM value at diagnosis was significantly associated with platelet count (P = 0.023), alanine aminotransferase (P = 0.045), albumin (P < 0.001), total bilirubin (P = 0.004) and prothrombin time (P = 0.005). However, additional correlation analysis between the changes in LSM value and biochemical factors from diagnosis to recovery showed that the change in total bilirubin was found to be the only factor associated with the change in the LSM value (P < 0.001). Conclusions: Our data suggest that the LSM value might be influenced by serum total bilirubin in patients with acute hepatitis without pre-existing underlying chronic liver disease.