Abstract
Background and aimThe role of non-invasive methods to evaluate fibrosis severity of chronic hepatitis C (CHC) subjects in community needs to be explored. This study investigated FIB-4 and transient elastography (TE) in staging liver fibrosis of CHC subjects in community.MethodsA total of 905 subjects who were positive for anti-HCV antibody from five districts of Tainan City of Taiwan were invited to participate in surveillance activities for CHC. FIB-4 and TE were measured for each participant.ResultsA total of 502 subjects with detectable HCV RNA and valid TE were enrolled. The distribution of FIB-4 and TE values differed markedly. Both methods exhibited a strongest correlation in subjects with at age 50~60 years (r = 0.655, p <0.001). FIB-4 score increased proportionally with age (p <0.001), but TE did not (p = 0.142). The intraclass correlation efficient of both methods was 0.255 (p <0.001). Subjects with TE defined advanced fibrosis exhibited younger age, higher BMI, higher platelet count, lower FIB-4 score, higher incidence of fatty liver and splenomegaly, and higher controlled attenuation parameter value than those defined by FIB-4. By multivariate logistic regression analysis, higher ALT levels, higher incidence of fatty liver, and presence of splenomegaly were the independent factors associated with advanced fibrosis defined by TE rather than defined by FIB-4.ConclusionsFIB-4 and TE defined different distribution of fibrosis stages in same HCV population. FIB-4 was deeply influenced by age whereas TE was not. TE had the advantages over than FIB-4 in strong association with splenomegaly and in detecting the role of non-alcoholic fatty liver disease in advanced fibrosis.
Highlights
More than 170 million people are infected with hepatitis C virus (HCV)
This study investigated FIB-4 and transient elastography (TE) in staging liver fibrosis of chronic hepatitis C (CHC) subjects in community
A total of 905 subjects who were positive for anti-HCV antibody from five districts of Tainan City of Taiwan were invited to participate in surveillance activities for CHC
Summary
Chronic HCV infection leads to the development of chronic hepatitis, liver cirrhosis and associated complications, hepatocellular carcinoma, and liver-related mortality [1,2,3]. Treatment to eradicate HCV provides benefits with respect to both liver- related or extrahepatic morbidity and mortality [4]. Patients with CHC and advanced fibrosis have a higher incidence of cirrhosis-related complications and are more likely to need a liver transplant [8,9,10]. A strategy for treating CHC patients sequentially in a manner that accounts for the severity of liver fibrosis is reasonable, evidence-based, and suggested in the EASL HCV treatment guidelines [13]. The two widely used non-invasive methods for identifying and classifying a stage of fibrosis are FIB-4 and the measurement of liver stiffness by transient elastography (TE). Based on the fundamental difference between the FIB-4 and TE methods, analyzing the features of a CHC population with various stages of fibrosis is of interest
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