At least two criteria from each group were required to establish the diagnosis of cirrhosis. Liver biopsy was performed in the remaining 94 patients. On the

same study day, patients underwent a complete ultrasound examination of the upper abdomen, measurement of liver stiffness by TE, and ultrasound-guided Selleck AG 14699 percutaneous liver biopsy. The following clinical and biological parameters were determined on the study day: body mass index (BMI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), Y-glutamyl-transpeptidase (GGT), total bilirubin, platelet count, INR, albumin, glucose, and creatinine. In addition to the initial 31 patients classified as “cirrhotic,” the diagnosis of cirrhosis (Metavir F4) was based on the results of the liver biopsy performed at the time of the study in an additional nine patients, for a total of 40 patients in Metavir stage F4. All these patients underwent upper gastrointestinal (GI) endoscopy within 1 week from the study day in order to assess the presence of esophageal varices, congestive gastropathy, and other abnormalities related to portal hypertension.

The nature of the study was explained to all patients, each of whom provided written informed consent before the beginning of the study, in accordance with the principles of the Declaration of Helsinki (revision of Edinburgh, 2000). The selleck chemical major clinical and biochemical parameters of the patients included in the study stratified by the Metavir stage of liver fibrosis

(F0-F1, F2-F3, and F4) are listed in Table 1. TE was performed after a complete ultrasound examination of the upper abdomen using the FibroScan apparatus (Echosens, Paris, France) as described.9 Measurements were performed after an overnight fasting (baseline MCE values) and 15, 30, 45, 60, and 120 minutes following the intake of a standardized liquid meal (Ensure Plus Drink, Abbot Laboratories, Zwolle, the Netherlands): 400 mL, 600 Kcal, 16.7% protein, 53.8% carbohydrates, 29.5% fat. The ingestion of the meal was achieved within a maximum period of 5 minutes in all patients, and the onset of the ingestion was taken as time zero. Since the upright posture has been reported to blunt postprandial hyperemia in patients with cirrhosis,10 LS measurements were performed maintaining all patients in the recumbent position after the onset of the meal. Before the beginning of the study, 400 mL of water were administered to 20 patients (all from AOUC) with HCV-related chronic liver disease (F0: n = 3, F1: n = 5, F2: n = 5, F3: n = 3, F4: n = 4) and LS measurements were performed at the same timepoints (baseline, 15, 30, 45, 60, 120 minutes) in order to evaluate potential artifacts due the administration of an identical liquid volume.