Fibrosis In Chronic Viral Hepatitis Research Articles

Metabolic syndrome is associated with severe fibrosis in chronic viral hepatitis and non‐alcoholic steatohepatitis

SummaryBackground The prevalence of metabolic syndrome and its possible impact on the severity of liver histological lesions have not been studied prospectively in chronic liver diseases.Aim To investigate the prevalence of metabolic syndrome in patients with chronic viral hepatitis or non‐alcoholic steatohepatitis, and to determine its associations with histological severity.Methods We prospectively included 317 patients (hepatitis B e antigen‐negative chronic hepatitis B: 95, chronic hepatitis C: 176, non‐alcoholic steatohepatitis: 46) with liver biopsy. Metabolic syndrome was defined using the Adult Treatment Panel III criteria. Histological lesions were evaluated according to Ishak’s or Brunt’s classification.Results Metabolic syndrome was present in 10.4% of patients being significantly more prevalent in non‐alcoholic steatohepatitis than in chronic viral hepatitis (41.3% vs. 5.1%, P < 0.001). In chronic viral hepatitis, cirrhosis (stages 5–6) was independently associated with increasing age, higher aspartate aminotransferase and gamma‐glutamyl‐transpeptidase levels, severe necroinflammation and metabolic syndrome (P = 0.016). In non‐alcoholic steatohepatitis, severe fibrosis (stages 3–4) was independently associated with severe necroinflammation and metabolic syndrome (P = 0.033). Presence of metabolic syndrome was not associated with presence or severity of steatosis both in chronic viral hepatitis and in non‐alcoholic steatohepatitis.Conclusion Metabolic syndrome is more prevalent in non‐alcoholic steatohepatitis than in chronic viral hepatitis; it is associated independently with more severe fibrosis but not with the severity of steatosis, both in chronic viral hepatitis and in non‐alcoholic steatohepatitis.

Real-Time Elastography for Noninvasive Assessment of Liver Fibrosis in Chronic Viral Hepatitis

Recently, transient elastography (FibroScan) has been introduced for noninvasive staging of liver fibrosis. Here, we investigated a novel approach for noninvasive assessment of liver fibrosis using sonography-based real-time elastography, which can be performed with conventional ultrasound probes during a routine sonography examination. Real-time elastography was performed in 79 patients with chronic viral hepatitis and known fibrosis stage and in 20 healthy volunteers. A specially developed program was used for quantification of tissue elasticity. Stepwise logistic regression analysis was performed to define an elasticity score using variables with high reproducibility in a preceding analysis of data from 16 different patients. In addition, aspartate transaminase-to-platelet ratio index (APRI) and routine laboratory values were included in the analysis. The Spearman's correlation coefficient between the elasticity scores obtained using real-time elastography and the histologic fibrosis stage was 0.48, which is highly significant (p < 0.001). The diagnostic accuracy expressed as areas under receiver operating characteristic (ROC) curves were 0.75 for the diagnosis of significant fibrosis (fibrosis stage according to METAVIR scoring system [F] > or = F2), 0.73 for severe fibrosis (F > or = F3), and 0.69 for cirrhosis. For a combined elasticity-laboratory score, the areas under the ROC curves were 0.93, 0.95, and 0.91, respectively. Real-time elastography is a new and promising sonography-based noninvasive method for the assessment of liver fibrosis in patients with chronic viral hepatitis.

529 Real-time elastography for non-invasive assessment of liver fibrosis in chronic viral hepatitis

529 Real-time elastography for non-invasive assessment of liver fibrosis in chronic viral hepatitis

Thrombotic factors and extent of liver fibrosis in chronic viral hepatitis: George V Papatheodoridis, Evmorfia Papakonstantinou, Acad Dept of Medicine, Hippokration Gen Hosp, Athens Greece; Evangelia Andrioti, 1st R Transfusion-Haemophilia Ctr, Hippokration Hosp, Athens Greece; Evangelos Cholongitas, Acad Dept of Medicine, Hippokration Gen Hosp, Athens Greece; Kalliopi Petraki, Pathology Dept, Hippokration General Hospital, Athens Greece; Irene Kontopoulou, 1st R Transfusion-Haemophilia

Thrombotic factors and extent of liver fibrosis in chronic viral hepatitis: George V Papatheodoridis, Evmorfia Papakonstantinou, Acad Dept of Medicine, Hippokration Gen Hosp, Athens Greece; Evangelia Andrioti, 1st R Transfusion-Haemophilia Ctr, Hippokration Hosp, Athens Greece; Evangelos Cholongitas, Acad Dept of Medicine, Hippokration Gen Hosp, Athens Greece; Kalliopi Petraki, Pathology Dept, Hippokration General Hospital, Athens Greece; Irene Kontopoulou, 1st R Transfusion-Haemophilia

Serum markers detect the presence of liver fibrosis: A cohort study

Histologic examination of a liver biopsy specimen is regarded as the reference standard for detecting liver fibrosis. Biopsy can be painful and hazardous, and assessment is subjective and prone to sampling error. We developed a panel of sensitive automated immunoassays to detect matrix constituents and mediators of matrix remodeling in serum to evaluate their performance in the detection of liver fibrosis. In an international multicenter cohort study, serum levels of 9 surrogate markers of liver fibrosis were compared with fibrosis stage in liver biopsy specimens obtained from 1021 subjects with chronic liver disease. Discriminant analysis of a test set of samples was used to identify an algorithm combining age, hyaluronic acid, amino-terminal propeptide of type III collagen, and tissue inhibitor of matrix metalloproteinase 1 that was subsequently evaluated using a validation set of biopsy specimens and serum samples. The algorithm detected fibrosis (sensitivity, 90%) and accurately detected the absence of fibrosis (negative predictive value for significant fibrosis, 92%; area under the curve of a receiver operating characteristic plot, .804; standard error, .02; P < .0001; 95% confidence interval, .758-.851). Performance was excellent for alcoholic liver disease and nonalcoholic fatty liver disease. The algorithm performed equally well in comparison with each of the pathologists. In contrast, pathologists' agreement over histologic scores ranged from very good to moderate (kappa = .97-.46). Assessment of liver fibrosis with multiple serum markers used in combination is sensitive, specific, and reproducible, suggesting they may be used in conjunction with liver biopsy to assess a range of chronic liver diseases.

576 Liver elasticity measurement by ultrasonic transient elastography: a new non-invasive method for assessment of liver fibrosis in chronic viral hepatitis

576 Liver elasticity measurement by ultrasonic transient elastography: a new non-invasive method for assessment of liver fibrosis in chronic viral hepatitis

Is serum hyaluronan a helpful tool in the management of patients with liver diseases?

The results of serial determinations of serum hyaluronan indicate a prognostic value in progressive liver damage. In primary biliary cirrhosis and in cirrhotic alcoholic liver diseases serum hyaluronan level discriminates between early and advanced disease. In alcoholic liver disease serum hyaluronan can be applied as assessment of haemodynamic changes. Serum hyaluronan is of use as a non-invasive index of liver fibrosis in chronic viral hepatitis. A reversible defect in the hyaluronan receptor of the hepatic endothelial cells was suggested following studies on paracetamol-induced acute liver damage. In liver transplantation, graft function can be predicted by determination of the venous effluent of hyaluronan.

Diagnostic accuracy of hyaluronan and type III procollagen amino-terminal peptide serum assays as markers of liver fibrosis in chronic viral hepatitis C evaluated by ROC curve analysis

Diagnostic accuracy of two serum markers of liver fibrosis, hyaluronan (HA) and amino-terminal peptide of type III procollagen (P-III-P), was studied in a cohort of 326 untreated patients with chronic viral hepatitis C. Both P-III-P (RIA-gnost P-III-P, Behring Diagnostic) and HA (HA-test, Pharmacia) serum concentrations correlated with the histological grades of liver fibrosis (P < 0.001). Receiver-operating characteristic (ROC) curves showed that serum HA had greater diagnostic performance than P-III-P, both for discriminating patients with extensive liver fibrosis from those with no or mild fibrosis (area under the ROC curves: 0.864 vs 0.691, P <0.001) or for discriminating patients with cirrhosis from those without cirrhosis (area under the ROC curves: 0.924 vs 0.734, P <0.001). At cutoff values of 0.8 kU/L for serum P-III-P and 85 micrograms/L for serum HA, sensitivities were 70.0% and 64.5%, and specificities were 63.4% and 91.2%, respectively, for discriminating patients with extensive liver fibrosis from those with no or mild fibrosis. At the cutoff values of 1.0 kU/L for serum P-III-P and 110 micrograms/L for serum HA, sensitivities were 60.0% and 79.2%, and specificities were 74.0% and 89.4%, respectively, for discriminating patients with liver cirrhosis from those without cirrhosis. We conclude that, because the diagnostic accuracy of serum HA is greater than that of serum P-III-P as a marker of liver fibrosis, serum HA should be preferred when monitoring liver fibrosis in patients with chronic viral hepatitis C.

Interest of hyaluronic acid (HA) in assessment of liver fibrosis in chronic viral hepatitis C

Interest of hyaluronic acid (HA) in assessment of liver fibrosis in chronic viral hepatitis C

Hyaluronan is of greater clinical value than aminoterminal peptide of type III procollagen for discrimination of liver fibrosis in chronic viral hepatitis C: A study in 326 untreated patients: J. Guéchot, A. Loria, L. Serfaty, O. Chazouillères, R. Poupon, J. Giboudeau. Service de Biochimie A et Unité d' Hépatologie, Hôpital Saint-Antoine, 75571 Paris, France

Hyaluronan is of greater clinical value than aminoterminal peptide of type III procollagen for discrimination of liver fibrosis in chronic viral hepatitis C: A study in 326 untreated patients: J. Guéchot, A. Loria, L. Serfaty, O. Chazouillères, R. Poupon, J. Giboudeau. Service de Biochimie A et Unité d' Hépatologie, Hôpital Saint-Antoine, 75571 Paris, France

Serum hyaluronan as a marker of liver fibrosis in chronic viral hepatitis C: effect of α-interferon therapy

Background/Aims: It has been suggested that increases in serum hyaluronan levels might be a marker of fibrosis in chronic viral hepatitis C. Patients receiving α-interferon therapy are an excellent model to determine the relationship between serum hyaluronan and liver fibrosis, since results suggest that α-interferon could reduce liver fibrosis. Methods: We studied the relationship between serum hyaluronan and histopathological indices of liver fibrosis, inflammation and necrosis, before and after α-interferon therapy (3 MU, three times weekly for 6 months), and the effect of treatment on serum hyaluronan and on histological liver fibrosis, in 52 patients. Hyaluronan levels were measured using a radiometric assay and the liver histopathological indices were scored according to the Knodell system. Results: The serum hyaluronan level correlated with the extent of liver fibrosis both before and after α-interferon therapy ( p<0.0001), but not with the histopathological indices of liver inflammation or necrosis. Parallel changes in serum hyaluronan and liver fibrosis occurred: serum hyaluronan levels feel significantly in patients in whom fibrosis improved ( p<0.01, n=11), increased significantly in patients in whom fibrosis worsened ( p<0.05, n=10), and did not change significantly in patients in whom fibrosis was unmodified ( n=31). Furthermore, fibrosis improved only when the antiviral effect of α-interferon was reflected by persistent normalization of serum alanine amino-transferase, although there was no correlation between serum hyaluronan levels and alanine amino-transferase activities. Conclusion: Serum hyaluronan thus appears to be a non-invasive index of liver fibrosis.

Serum hyaluronan and liver fibrosis in chronic viral hepatitis C: Effect of interferon-$alpha; therapy

Serum hyaluronan and liver fibrosis in chronic viral hepatitis C: Effect of interferon-$alpha; therapy