From the Research
The threshold for FibroScan in patients over 65 years old is generally considered to be around 8.0-8.5 kPa for significant fibrosis and 12.5-14.5 kPa for cirrhosis, as suggested by various studies 1, 2. When interpreting FibroScan results in older adults, it's essential to consider that liver stiffness naturally increases with age, even in the absence of liver disease, due to changes in liver architecture, reduced elasticity of tissues, and increased collagen deposition that comes with normal aging 3. Additionally, older patients often have comorbidities like diabetes, obesity, or cardiovascular disease that can affect liver stiffness measurements. For the most accurate assessment, FibroScan results should be interpreted alongside other clinical parameters, laboratory findings, and the patient's complete medical history. Some studies suggest that a cutoff value of 14.6 kPa can be used to diagnose cirrhosis with high accuracy, with a positive predictive value of 74% and a negative predictive value of 96% 4. However, it's crucial to note that the optimal cutoff values may vary depending on the etiology of liver disease and individual patient factors, as highlighted in a study that found optimal cut-offs at ≥11.7, ≥15.2, and ≥21.2 kPa for F2, F3, and F4, respectively 2. If the results are borderline or unclear, additional testing such as liver biopsy might be considered, though the risks and benefits should be carefully weighed in elderly patients. Key factors to consider when interpreting FibroScan results include:
- The patient's age and potential age-related changes in liver stiffness
- The presence of comorbidities that may affect liver stiffness measurements
- The etiology of liver disease and potential variations in optimal cutoff values
- The need for additional testing, such as liver biopsy, in cases with borderline or unclear results.