Abstract
Cirrhosis commonly complicates portal hypertension worldwide but in Zambia hepatosplenic schistosomiasis (HSS) dominates as the cause of portal hypertension. We need easier and non-invasive ways to assess HSS. Transient elastography (TE), a measure of liver stiffness can diagnose liver cirrhosis. TE remains unexplored in HSS patients, who generally have normal liver parenchyma. We aimed to explore liver stiffness in HSS. This nested case control study was conducted at the University Teaching Hospital, Lusaka, Zambia between January 2015 and January 2016. We enrolled 48 adults with HSS and 22 healthy controls. We assessed liver stiffness using TE while plasma hyaluronan was used to assess liver fibrosis. Plasma tumor necrosis factor receptor 1 (TNFR1) and soluble cluster of differentiation 14 (sCD14) were used to assess inflammation. The median (interquartile range) liver stiffness was higher in patients, 9.5 kPa (7.8, 12.8) than in controls, 4.7 kPa (4.0, 5.4), P < 0.0001. We noted linear correlations of hyaluronan and TNFR1 with the liver stiffness, P = 0.0307 and P = 0.0003 respectively.HSS patients seem to have higher liver stiffness than healthy controls. TE may be useful in identifying fibrosis in HSS. The positive correlations of inflammatory markers with TE suggest that HSS has both periportal and parenchymal pathophysiology.
Highlights
Hepatosplenic schistosomiasis (HSS) in the tropics is an important cause of portal hypertension and contributes significantly to mortality and morbidity (Berhe et al, 2007; Kibiki et al, 2004; Sinkala et al, 2016)
Studies involving the Transient elastography (TE) in patients with chronic hepatitis B, C viral infections and non-alcoholic fatty liver disease have shown that TE could be superior in assessing liver fibrosis than the aspartate aminotransferase-to-platelet ratio index (APRI) score it is not
We measured liver stiffness in a well-characterized group of Zambians with advanced HSS and noted elevated liver stiffness compared with controls
Summary
Hepatosplenic schistosomiasis (HSS) in the tropics is an important cause of portal hypertension and contributes significantly to mortality and morbidity (Berhe et al, 2007; Kibiki et al, 2004; Sinkala et al, 2016). Cirrhosis is the leading cause of portal hypertension worldwide, in Zambia a large proportion of cases are non-cirrhotic and are due to schistosomiasis (Sinkala et al, 2016). Its clinical use in patients with liver disease is increasing and has proved to be reliable (Pang et al, 2014) It can be performed on an outpatient basis and this imaging technique takes about 5–10 min only. TE has been useful as a non-invasive tool in assessing liver fibrosis and cirrhosis in HBV and HCV infected patients. It is useful in predicting variceal bleeding in patients with portal hypertension (Myers et al, 2010; Jung and Kim, 2012)
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