Assessment Of Fibrosis In Chronic Hepatitis Research Articles

Non-Invasive Assessment of Liver Fibrosis in Hepatitis B Patients.

The aim of this review is to provide updated information on the clinical use of non-invasive serum and imaging-based tests for fibrosis assessment in chronic hepatitis B (CHB) virus infection. In recent years, non-invasive tests (NIT) have been increasingly used to determine eligibility for treatment. Liver biopsy is still considered the gold standard for assessing inflammatory activity and fibrosis staging, but it is an invasive procedure with inherent limitations. Simple serum markers such as APRI and FIB-4 are limited by indeterminate results but remain useful initial tests for fibrosis severity if imaging elastography is not available. Point-of-care US-based elastography techniques, such as vibration-controlled transient elastography or 2D shear wave elastography, are increasingly available and have better accuracy than simple serum tests for advanced fibrosis or cirrhosis, although stiffness cut-offs are variable based on E-antigen status and inflammatory activity. Current NITs have poor diagnostic performance for following changes in fibrosis with antiviral therapy. However, NITs may have greater clinical utility for determining prognosis in patients with CHB that have advanced disease, especially for the development of hepatocellular carcinoma and/or liver decompensation. Algorithms combining serum and imaging NITs appear promising for advanced fibrosis and prognostic risk stratification.

Liver stiffness in chronic hepatitis C virus infection.

The severity of liver fibrosis can be assessed noninvasively today by liver stiffness measurements. Vibration-controlled transient elastography, shear wave elastography or magnetic resonance elastography are techniques increasingly used for this purpose. This article presents the recent advances in the use of new techniques for liver fibrosis assessment in chronic hepatitis C: the correlation between liver stiffness values and liver fibrosis estimated by liver biopsies, the prognosis role of liver stiffness values, their usefulness in monitoring the treatment response, in assessing the severity of portal hypertension and in estimating the presence of esophageal varices. Scientific articles from January 2017 to January 2018 were searched in PubMed and PubMed Central databases, using the terms "liver stiffness" and "hepatitis C". The median liver stiffness values measured with different techniques are not identical, so that FibroScan thresholds cannot be used on any other elastographic machine. The higher the liver's stiffness measurement, the higher the liver-related events in patients with chronic hepatitis C. A liver stiffness measurement over 17 kPa could be an independent predictor for the presence of esophageal varices as well as a spleen with a longitudinal span ≥ 15 cm for patients with a value of liver stiffness < 17 kPa. A progressive and persistent decrease in liver stiffness is dependent on sustained virological response achievement. The lack of liver stiffness decrease has been associated with relapsers and a low value of liver stiffness at baseline. Liver stiffness provides clues about the severity and evolution of liver disease.

THU-242-Clinical non-invasive markers for hepatic inflammation and fibrosis assessment in chronic hepatitis B with normal alanine aminotransferase

THU-242-Clinical non-invasive markers for hepatic inflammation and fibrosis assessment in chronic hepatitis B with normal alanine aminotransferase

Noninvasive methods for fibrosis assessment in chronic hepatitis C virus infection

Objective The objective of this study is to compare several noninvasive methods of fibrosis assessment (platelet count, the aspartate aminotransferase/platelet ratio index, the Lok score, and the fibrosis-4 score) versus percutaneous liver biopsy (LB) in chronic hepatitis C virus infection. Background Noninvasive methods for assessment of hepatic fibrosis are increasingly needed. LB is an invasive procedure and includes a risk of complications, such as pain, pneumothorax, puncture of other viscera, and hemorrhage. In addition to the added cost, LB cannot be performed universally in all patients with impaired hemostasis of any origin. Patients and methods Our study included 500 patients with chronic hepatitis C virus infection in which LB and biological tests needed for calculating the scores (according to the classic formulas) were performed. Results There was a highly significant correlation between different stages of fibrosis and all studied markers of fibrosis (P < 0.001). Lok score at a cutoff value of 0.25 had 68.73% sensitivity and 55% specificity for diagnosis of liver fibrosis, fibrosis-4 score at a cutoff value of 1.26 had 55.9% sensitivity and 68.54% specificity, aspartate aminotransferase/platelet ratio index at a cutoff value of 0.66 had 50.0% sensitivity and 74.16% specificity, and platelet count at a cutoff value of 208 (103/mm3) had 67.7% sensitivity and 59.55% specificity for diagnosis of liver fibrosis. Conclusion All studied noninvasive markers of fibrosis are very good markers for detection of fibrosis.

Prospective comparison of transient elastography and liver biopsy for the assessment of fibrosis in chronic hepatitis C infection

HCV is a worldwide problem and the need to assess the degree of fibrosis is the corner stone in its treatment. Liver biopsy has been used for years to assess the degree of fibrosis and activity but recently many non-invasive methods have emerged to replace it as aspartate transaminase/platelet ratio [APRI), abdominal ultrasonography measuring caudate/right lobe ratio and hepatic stiffness [Fibroscan). PurposeCorrelate the accuracy of Transient Elastography [Fibroscan) in comparison to liver biopsy as a non-invasive method for fibrosis assessment in chronic hepatitis C patients. MethodsThe study was done on 50 patients with chronic HCV [32 males and 18 females) for which liver biopsy and fibroscan were performed. ResultsThere was positive correlation of liver biopsy with fibroscan score, there was moderate agreement [matching) between liver biopsy and fibroscan the lowest matching were in F0 and the highest were in F3. ConclusionFibroscan has a good matching with liver biopsy in the detection of hepatic fibrosis and follow up of its progression.

Acoustic radiation force impulse elastography and serum fibrosis markers in chronic hepatitis C

Objective. Liver biopsy (LB) remains the gold standard for the assessment of liver fibrosis, although it is invasive and can have complications. The present study compares several noninvasive methods of fibrosis assessment in chronic hepatitis C (CHC), including acoustic radiation force impulse (ARFI) elastography, aspartate aminotransferase:platelet ratio index (APRI), Forns, FIB-4, and King scores versus percutaneous LB. Material and methods. This prospective study enrolled 51 untreated CHC patients. Biological tests necessary for the calculation of the scores (according to the classic formulas) were performed within a week of LB. The time interval between LB and tissue stiffness, assessed according to the Metavir score, was <6 months. Cutoff values were determined using area under receiver-operating characteristic curves (AUROC). Results. The best test for predicting significant fibrosis (F ≥2 Metavir) was ARFI elastography with an AUROC of 0.90, followed by FIB-4 (AUROC = 0.86), King (AUROC = 0.85), Forns (AUROC = 0.84), and APRI (AUROC = 0.82). For a cutoff of 1.31 m/s, ARFI had 89.3% sensitivity (Se) and 87% specificity (Sp). The best test for predicting cirrhosis was ARFI elastography with an AUROC of 0.98, followed by FIB-4 (AUROC = 0.94), King (AUROC = 0.90), APRI (AUROC = 0.82), and Forns (AUROC = 0.81). For a cutoff of 1.95 m/s, ARFI had 100% Se and 95.2% Sp. Conclusion. ARFI elastography had very good accuracy for the assessment of liver fibrosis. It was more effective than APRI, Forns, King, and FIB-4 scores for the prediction of significant fibrosis and cirrhosis in CHC patients.

Noninvasive Methods to Evaluate Liver Fibrosis in Chronic HCV Infection

Sirli et al.'s (1) effort to compare several noninvasive methods of fibrosis assessment in chronic hepatitis C virus (HCV) infection is commendable. Their study evaluated several simple serological tests for the prediction of fibrosis in chronic HCV infection: number of platelets, the aspartate aminotransferase–platelet ratio index (APRI test), the Forns score, the Lok score, and the FIB-4 score. They also compared these tests to liver stiffness measurement (LSM) by transient elastography (TE) and to the current “gold standard”: liver biopsy (LB). They concluded that LSM was the best method for predicting cirrhosis, but all the evaluated tests had excellent predictive value (1). We have to keep in mind that LSM failure can occur in 2%-10% of patients, and this is generally related to obesity, especially with the use of the M probe. For almost all causes of chronic liver disease, assessment of fibrosis is important in estimating the prognosis of and determining the surveillance strategy for liver cancer. In addition, for chronic viral hepatitis, the degree of liver fibrosis is one important parameter for decisions of antiviral therapy. LB is still the standard and most commonly used procedure in the assessment of liver fibrosis. However, it is an invasive method associated with patient discomfort and in rare cases with serious complications. LBs are generally not performed in HCV patients with bleeding disorders because of increased bleeding risk and high costs. Antiviral treatment is only effective in 50% of these patients and is often accompanied by serious side effects. Consequently, careful selection of patients for treatment is warranted, and. assessment of liver fibrosis and cirrhosis noninvasively using LSM is an adequate alternative to LB (2). The importance of using a combination of noninvasive tests for proper assessment of fibrosis in HCV patients has always been stressed. Recently, a series of algorithms based on sequential combination of noninvasive serum markers showed 93%-95% accuracy in the detection or exclusion of significant liver fibrosis and a reduction of 50% of liver biopsies in this subset of patients with HCV infection (3). Par A and Par G concluded that both APRI and LSM results correlated with the METAVIR score, but LSM identified fibrosis better than APRI (4). Likewise, Corradi and colleagues showed that LSM provides good accuracy in identifying patients with significant fibrosis and performs better than noninvasive indexes (5). Similarly, Sirli et al. found that LSM by means of TE seems to be more sensitive than other noninvasive tests, Archive of SID

Non-invasive fibrosis assessment in chronic hepatitis C: aspartate-aminotransferase to platelet ratio index (APRI) and transient elastography (FibroScan)

Although liver biopsy is the gold standard for the diagnosis of liver disease, non-invasive tests may also play a role in the evaluation of liver fibrosis. Authors studied two fibrosis markers, aspartate-aminotransferase / platelet ratio index (APRI) and liver stiffness (LS) measurement to assess fibrosis in different forms of chronic hepatitis C virus (HCV) infection. out of 119 HCV-infected patients 75 had biopsy-proven chronic hepatitis C, 24 had HCV-cirrhosis, 20 individuals were symptom-free HCV-carriers with persistently normal alanine-aminotransferase and 30 healthy blood donors served as controls. Wai's APRI score was calculated from aspartate-aminotransferase and platelet number. For LS measurement transient elastography (FibroScan) was applied. METAVIR fibrosis score was determined by liver biopsy. In patients with chronic hepatitis C infection both fibrosis markers were significantly elevated comparing to normal controls and the markers were the highest in HCV-associated cirrhosis. Values of symptom-free HCV-carriers corresponded to those obtained from healthy controls. Both APRI and LS results correlated with the METAVIR score. LS identified fibrosis better than APRI. Using a novel sequential algorithm that comprises APRI and LS for assessment of fibrosis, 47.8% of HCV patients did not need biopsy for diagnosing significant (F≥2) fibrosis. both fibrosis markers, particularly in combination, may represent a useful option in the noninvasive assessment of fibrosis in HCV infection.