Controlled Attenuation Parameter for Noninvasive Assessment of Hepatic Steatosis Using Fibroscan^sup ^: Validation in Chronic Hepatitis B

The controlled attenuation parameter (CAP) using transient elastography (TE) was validated in chronic hepatitis C to evaluate hepatic steatosis; however, limited data are available on chronic hepatitis B (CHB). Therefore, we assessed the accuracy and the efficacy of CAP for the detection of steatosis in CHB. Consecutive CHB patients underwent liver biopsy and liver stiffness measurements (LSM) with simultaneous CAP determination using the M probe of the TE. The area under the receiver operating characteristics curve (AUROC) was used to evaluate the performance of CAP in diagnosing steatosis compared with biopsy. A total of 340 patients were included: 60 % were male, the median age was 37 years; the body mass index (BMI) was >=28 kg/m^sup 2^ for 14 % of the subjects; and the distribution of the steatosis grade was S0 58.2 %, S1 34.2 %, S2 5.0 % and S3 2.6 %. The median (range) of CAP was 218 (100-400) dB/m, and CAP correlated with the BMI ([rho] = 3.622) and steatosis grade ([rho] = 29.203) according to a multivariate analysis (both P < 0.001). CAP could detect the different grades of steatosis: >=S1 with AUROC of 0.81 at a cutoff of 224 dB/m, >=S2 with AUROC of 0.90 at a cutoff of 236 dB/m and >=S3 with AUROC of 0.97 at a cutoff of 285 dB/m. Furthermore, the LSM and fibrosis and activity grades on biopsy did not influence the CAP performance. CAP presented excellent diagnostic performance for severe steatosis with high sensitivity and specificity in Chinese patients with CHB.[PUBLICATION ABSTRACT]