Supplementary Material for: Liver stiffness determined by transient elastography is a simple and highly accurate predictor for presence of liver cirrhosis in clinical routine

Introduction: Early detection of patients with advanced chronic liver disease is critical for prevention of complications and inclusion in surveillance programs for hepatocellular carcinoma. In daily clinical care, it remains challenging to differentiate early cirrhosis from lower fibrosis grades without performing a liver biopsy. Aim of the present study was to assess performance of different non-invasive detection tools to differentiate cirrhosis from lower fibrosis grades. Methods: Data of 116 patients (51 male, 65 female) with chronic liver disease of various origin undergoing liver biopsy was analysed. Routine laboratory values, liver stiffness measurement (LSM) by transient elastography, and histological liver assessment were collected. Results: Robust and significant correlations with the histological fibrosis stage were identified for LSM (r=0.65), the FAST score (0.64), the FIB-4 (0.48), serum AST concentration (0.41) NFS (0.33), INR (0.30), methacetin breath test results (-0.40), and serum albumin concentration (-0.29) by spearman rank correlation. ROC curves were built for these parameters to separate patients with cirrhosis from those with any other fibrosis stage. The highest AUC was achieved by LSM (0.9130), followed by the FAST score, (0.8842), the FIB-4 (0.8644), the NFS (0.8227), INR (0.8142), serum albumin (0.7710), and serum AST (0.7620). The most promising clinical applicability would be an LSM value of 12.2 kPa achieving 95.7% sensitivity and 75.3% specificity. Conclusion: LSM and FAST score seem to be robust non-invasive measurements for liver fibrosis. LSM and FAST score may have potential to reliably detect patients with liver cirrhosis in clinical routine settings.