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We aimed to evaluate the diagnostic accuracy of liver stiffness measurement (LSM) in 188 chronic hepatitis B (CHB) patients with alanine transaminase (ALT) ≤ twice the upper limit of normal (ULN). Liver fibrosis was staged using METAVIR scoring system. Define significant fibrosis as F2-F4, severe fibrosis as F3-F4, and cirrhosis as F4. To predict F2-F4, the AUROC of LSM was higher than that of APRI (0.86  vs  0.73,  p  = 0.001) and FIB-4 (0.86  vs  0.61,  p  < 0.001). To predict F4, the AUROC of LSM was also higher than that of APRI (0.93  vs  0.77,  p  = 0.012) and FIB-4 (0.93  vs  0.64,  p  < 0.001). Patients with ALT levels 1–2 ULN had higher cut-off values than patients with normal ALT levels for the diagnosis of F2-F4 (6.5  vs  6 kPa) and F4 (10.2  vs  7.8 kPa). Using cut-off values regardless of ALT levels, the diagnostic accuracy of LSM was 81% for F2-F4, and 89% for F4. Applying ALT-stratified cut-off values, the diagnostic accuracy of LSM was 82% for F2-F4, and 86% for F4. In conclusion, LSM is a reliable noninvasive test for the diagnosis of liver fibrosis. Applying ALT-stratified cut-off values did not enhance diagnostic accuracy of LSM in CHB patients with ALT ≤ 2 ULN.

Diagnostic accuracy of liver stiffness measurement in chronic hepatitis B patients with normal or mildly elevated alanine transaminase levels