Comparative Study between Fibro-Test and Egy-Score as Non-Invasive Markers for Assessment of Hepatic Fibrosis in Chronic Hepatitis C

Abstract

Backgound: Liver fibrosis (LF) occurs in response to almost all causes of chronic liver injury. Assessing LF is important for both predicting disease progression and monitoring efficacy of therapeutic measures. Most noninvasive tests of liver fibrosis were developed with the aim of discriminating between “insignificant”, (F0-F1) by METAVIR and clinically “significant” fibrosis (≥ F2) by METAVIR or for identifying or excluding established cirrhosis in patients with well compensated chronic liver disease. Both these aims are clinically the most relevant. Aim: We aimed to compare the diagnostic accuracy of FibroTest and Egy-Score as predictors of stage of hepatic fibrosis in a prospectively enrolled cohort of Egyptian patients with chronic hepatitis C. Patients and Methodlogy: Twenty patients, treatment naive chronic hepatitis C patients were enrolled. They were 16 males (80%) and 4 females (20%) mean age of these patients was 53.55 +14.3 (rang 18_73 years). The study was carried out in the Department of Gastroenterology and Hepatology, Elhussin hospital, Al-Azhar University during the period between March 2016 and March 2018. Results: Our results showed a highly significant positive correlation between stage of hepatic fibrosis by METAVIR and fibrotest. Our results showed a highly significant positive correlation between stage of hepatic fibrosis by METAVIR and EGY-SCOR. Our scores depend mainly on simple routinely used laboratory parameters (total bilirubin, albumin, platelet count) in addition to age and 2 non routine tests (CA 19-9 and Alpha-2-Macroglobulin). Although this panel needs to be done in validated laboratories, the cost of our score is much cheaper than other well-known and patented tests such as FibroTest and the net results of both methods nearly the same. Conclusion: Egy-Score can be applied easily in clinical practice to exclude severe hepatic fibrosis/cirrhosis in patients with contraindication for liver biopsy or those who are reluctant to do it. Egy-score would need further valida‌tion to be regarded as an alternative to liver biopsy. Recommendations: Physician should be careful when interpreting elevated levels of tu‌mor markers CA 19-9 and CA 125 in patients with chronic liver disease as this could be a benign elevation related to hepatic fibrosis and not necessarily due to underlying malignancies. Elevation of the tumor markers such as CA19.9 have been associated with cholestasis in liver disease patients and this may give false positive results for our scores which give Limitations to our study.