What does a median liver stiffness of 6.02 kPa indicate?

Interpretation of Liver Stiffness Measurement of 6.02 kPa

A median liver stiffness of 6.02 kPa indicates normal or minimal fibrosis and is below the threshold for significant liver disease or advanced fibrosis in most clinical contexts. 1

Understanding Liver Stiffness Measurements

• Liver stiffness measurement (LSM) using transient elastography (FibroScan®) is a non-invasive method to assess liver fibrosis and is considered an excellent surrogate marker for advanced fibrosis and cirrhosis 1
• Values below 6 kPa are generally considered normal and typically exclude ongoing significant liver disease 1
• At 6.02 kPa, this measurement falls just slightly above the normal range but well below clinically significant thresholds for advanced fibrosis or cirrhosis 1

Clinical Significance by Disease Etiology

Hepatitis C

• For patients with hepatitis C, the American Gastroenterological Association (AGA) recommends a cutoff of 12.5 kPa for diagnosing cirrhosis 2
• A value of 6.02 kPa is significantly below this threshold, suggesting absence of cirrhosis in HCV patients 2

Hepatitis B

• In chronic hepatitis B, the AGA suggests a cutoff of 11.0 kPa to detect cirrhosis 2
• A measurement of 6.02 kPa is well below this threshold, indicating absence of cirrhosis in HBV patients 2

Alcoholic Liver Disease

• For alcoholic liver disease, a cutoff of 12.5 kPa is used to diagnose cirrhosis 2
• At 6.02 kPa, this value suggests minimal to no fibrosis in patients with alcoholic liver disease 2

Autoimmune Hepatitis

• In autoimmune hepatitis patients achieving biochemical remission, an average liver stiffness of 6.4 ± 3.2 kPa has been observed 2
• A value of 6.02 kPa is consistent with well-controlled disease in autoimmune hepatitis patients 2

Reliability Considerations

• For accurate interpretation, the reliability of the measurement should be assessed 3
• Reliable liver stiffness evaluations typically require:
  • ≥10 valid measurements
  • ≥60% success rate
  • Interquartile range/median ratio (IQR/M) ≤0.30 3
• A measurement with IQR/M ≤0.10 would be considered "very reliable" 3

Factors That May Influence Liver Stiffness Values

• Gender: Men typically have higher baseline liver stiffness values than women (5.81±1.54 vs 5.23±1.59 kPa in healthy subjects) 4
• BMI: Subjects with BMI>30 kg/m² tend to have higher liver stiffness values (6.26±1.89 vs 5.37±1.51 kPa) 4
• Metabolic syndrome: Can independently increase liver stiffness values (6.51±1.64 vs 5.33±1.51 kPa) 4
• Acute inflammation, congestion, or cholestasis can falsely elevate liver stiffness measurements 1

Prognostic Implications

• Patients with liver stiffness <10 kPa have a very low risk of liver-related complications 5
• A value of 6.02 kPa suggests excellent prognosis regarding risk of decompensation or mortality 5
• For patients with compensated cirrhosis, higher values (≥22 kPa) would indicate increased risk of decompensation 6

Clinical Recommendations

• A liver stiffness of 6.02 kPa does not require specific hepatology follow-up for fibrosis concerns if other clinical parameters are normal 1
• If the measurement was obtained during monitoring of known liver disease, this value suggests stable or improved liver health 5
• Any underlying risk factors for liver disease (alcohol use, metabolic syndrome, viral hepatitis) should still be addressed despite the reassuring liver stiffness value 4

Common Pitfalls to Avoid

• Do not interpret liver stiffness in isolation; always consider clinical context, laboratory values, and imaging findings 2
• Acute hepatitis, alcohol consumption within 24 hours, or right heart failure can falsely elevate liver stiffness measurements 1
• Technical limitations may affect accuracy, particularly in obese patients where failure rates increase significantly with BMI >40 kg/m² 4