Abstract
Background: Liver stiffness measurement (LSM) is crucial for appropriate fibrosis staging in patients with ongoing hepatitis C virus (HCV) infection. However, there is still an ongoing debate on the impact of serum transaminases (aspartate-aminotransferase, AST; alanine-aminotransferase, ALT) on LSM. Methods: We selected 110 patients undergoing HCV eradication therapy with LSM compatible with significant liver fibrosis. LSM was evaluated prior to therapy and one year after HCV eradication. Results: LSM showed a median decrease of 35% from baseline values, and 67 (61%) patients showed posttreatment values compatible with lower fibrosis stages. We developed two logistic regression models to determine the probability of liver fibrosis overestimation according to serum transaminase. The probability of overestimation of two or more fibrosis grade is equal to (1) 50% for AST of 99 IU/L (2.2 ULN) and ALT of 90.5 IU/L (2 ULN), (2) 80% for AST of 123.5 IU/L (2.74 ULN) and ALT of 101.5 IU/L (2.25 ULN), and (3) reaches 100% for AST of 211 IU/L (4.7 ULN) and ALT of 140 IU/L (3.1 ULN). Conclusions: This study highlights the impact of serum transaminases on LSM. We believe that our findings may serve as a reference point for appropriate fibrosis stratification by liver elastography in patients with HCV infection.
Highlights
Hepatitis C Virus (HCV) infection represents a significant cause of chronic liver disease, with approximately 70 million chronically infected individuals worldwide [1]
In the case of hepatitis C virus (HCV), the cytolysis of infected hepatocytes is mediated by perforin and granzyme B produced by cytotoxic T-lymphocytes [27]
Serum transaminase concentrations have been linked to the histological grading of necroinflammatory activity, and, as expected, patients with elevated alanine transaminases (ALT) generally show higher activity scores [28,29]. These concepts should be taken into consideration for a critical evaluation of liver elastography results as it has been proven that stiffness values are influenced by tissue congestion and inflammation, rather than the mere degree of collagen deposition [30,31]
Summary
Hepatitis C Virus (HCV) infection represents a significant cause of chronic liver disease, with approximately 70 million chronically infected individuals worldwide [1]. More recent findings showed that even patients with lesser ALT increase (≥2 ULN) had higher LSM if compared to patients with normal ALT [8,9] This hypothesis was further explored through a significant decrease of LSM in patients with hepatitis B virus (HBV) infection after 3months of antiviral treatment and ALT normalization [10]. To definitively assess the influence of liver inflammation on liver elastography, we evaluated changes in LSM in a cohort of patients with HCV infection and LSM compatible with severe liver fibrosis one year after the end of treatment. Liver stiffness measurement (LSM) is crucial for appropriate fibrosis staging in patients with ongoing hepatitis C virus (HCV) infection. We believe that our findings may serve as a reference point for appropriate fibrosis stratification by liver elastography in patients with HCV infection
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