Approximately 10�C20% of patients with chronic hepatitis B (CHB) infection have liver kinase inhibitor Imatinib Mesylate cirrhosis at first presentation, and an additional 20�C30% of patients will eventually develop this condition and its complications within one or more decades [3], [4]. Previous studies indicated an annual risk of developing hepatocellular carcinoma (HCC) of 1�C6%, and a similar or higher risk of hepatic decompensation after the development of cirrhosis [5], [6]. Although antiviral treatment using nucleot(s)ide analogues (NUCs) suppresses HBV effectively [7], liver-related events (LREs) including hepatic decompensation, HCC, and liver-related death still occur and remain an important watershed in the management algorithm of patients with CHB.

Because LREs usually develop in patients with advanced liver fibrosis and cirrhosis, the early detection of advanced liver fibrosis and cirrhosis and the assessment of their severity for the design of optimal surveillance and intervention strategies are important. Although liver biopsy (LB) has been the gold standard for assessing liver fibrosis to date [8], it is prone to sampling error and interpretational variability [9]. Recently, liver stiffness measurement (LSM) using transient elastography (FibroScan?) has been introduced for assessing liver fibrosis with accurate, reproducible, and reliable results [10], [11]. Furthermore, because LSM can be expressed numerically as a continuous variable, clinicians can grade the degree of liver fibrosis, even in patients with cirrhosis, and assess the risk of developing liver-related complications and HCC [12]�C[14].

Thus, we hypothesized that LSM could predict the development of LREs in CHB patients who were receiving antiviral treatment using NUCs due to histologically advanced liver fibrosis or cirrhosis with a high viral load. Previous cross-sectional studies have reported an association between LSM and the presence of liver-related complications or HCC in patients with CLD [12], [13], [15], [16]. However, few prospective longitudinal studies have investigated the role of LSM as a predictor of LRE development in patients with advanced liver fibrosis. Thus, we evaluated the usefulness of LSM in assessing the risk of LRE development in CHB patients showing histologically advanced liver fibrosis with a high viral load.

Batimastat Methods Patients Between March 2006 and April 2010, a total of 178 NUC-na?ve CHB patients underwent LB to assess the degree of liver fibrosis and necroinflammation before starting antiviral treatment at Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. CHB was defined as the persistent presence of serum hepatitis B surface antigen (HBsAg) for more than 6 months and HBV DNA positivity on a polymerase chain reaction (PCR) assay. Patients who provided written informed consent and received LB and LSM were consecutively enrolled in this prospective study.