Transient elastography detection of early liver fibrosis in idiopathic pulmonary fibrosis patients

Fibrosis of epithelial parenchymal organs and end-stage organ failure are the final common pathways of many chronic diseases and the major determinants of morbidity and mortality worldwide. Comparison studies of pulmonary, hepatic and renal fibrosis have identified common mechanisms, including a critical role for the cytokine transforming growth factor-beta and the generation of reactive oxygen species. Aim of this pilot study was to investigate any evidence of liver fibrosis in 25 consecutive patients affected by idiopathic pulmonary fibrosis (IPF) referring to our clinic (19 M; mean age±SD: 65.2±9.7yrs; 17 ex-smokers). Pulmonary functional assessment, liver function tests and hepatic viruses serology were preliminary performed in all cases. Patients with HBC or HCV infection were excluded. Liver imaging analysis and transient elastography were realized by two independent operators by means of conventional ultrasound tomography and Fibroscan. Mean lung function parameters of the study population were: FCV 67.1± 19.8 (%pred) and Hb-adjusted DLCO sb 45.9±16.8 (%pred). Liver function parameters were within the normal range in all cases. Mild to moderate steatosis was identified in 5 cases (20%). Interestingly, increased liver stiffness (8.3±1.5 kPa, normal range: 4.8-5.5 kPa) was detectable by Fibroscan analysis suggesting early hepatic fibrosis in 8 patients (32%). This preliminary small cohort study suggests that liver fibrosis may be present in approximately one-third of IPF patients. Apart from several limitations, this is the first attempt to include in clinical practice novel methodologies addressing in a more comprehensive fashion the complex phenotype of IPF.