Diagnostic Accuracy of a Nurse-Led Transient Elastography: A Study of a Tertiary Hospital Experience

Once thought rare, liver disease is an emerging cause of significant morbidity and mortality. The rising burden of liver disease necessitates a competent workforce to deliver quality healthcare to patients with liver diseases. Staging liver diseases is essential in disease management. Transient elastography as compared with liver biopsy, the gold standard in staging of the disease, has gained wide acceptance in this field. This study examines the diagnostic accuracy of nurse-led transient elastography in staging fibrosis in chronic liver diseases at a tertiary referral hospital. Audit of records to locate transient elastography and liver biopsy performed within 6 months of interval yielded 193 cases for this retrospective study. A data abstraction sheet was prepared for extracting the relevant data. The content validity index and reliability of the scale were above 0.9. The diagnostic accuracy of liver stiffness evaluation (in kPa) by nurse-led transient elastography to grade fibrosis was categorized as "significant and advanced" and tested against the Ishak staging of liver biopsy. SPSS v.25 was used to perform the analysis. All tests were two-sided at a .01 level of significance. Area under the receiver operating characteristic curve, a graphical plot, illustrated the diagnostic ability of nurse-led transient elastography for significant fibrosis as 0.93 (95% confidence interval [CI] 0.88-0.99; p < .001) and advanced fibrosis as 0.89 (95% CI 0.83-0.93; p < .001). Spearman's ρ correlation between liver stiffness evaluation and liver biopsy was significant ( p = .01). Nurse-led transient elastography showed a significant diagnostic accuracy in staging hepatic fibrosis irrespective of the etiology of chronic liver disease. Given the increase in chronic liver disease, introducing more such nurse-led clinics increases the potential for early detection and improves care outcomes for this population.