Hepatic Fibrosis In Chronic Hepatitis Research Articles

Clinical value of noninvasive method in diagnosing hepatic fibrosis about chronic HBV carriers

Objective: To compare the clinical value of FibroScan, FIB-4, APRI and AAR diagnosing hepatic fibrosis in chronic hepatitis B virus (HBV) carriers. Methods: A total of 213 patients with chronic HBV carriers diagnosed by clinical and liver biopsy were selected. And according to HBeAg status, 149 patients were divided into HBeAg-positive group and 64 patients were divided into HBeAg-negative group. The liver stiffness measurements (LSM) was measured by FibroScan (FS), FIB-4, APRI and AAR values were calculated using FIB-4, APRI and AAR formula. And all patients underwent liver biopsy in the same period. According to the degree of hepatic fibrosis in Knodell, one decision point was set: significant hepatic fibrosis (S ≥ 2). The Spearman correlation analysis method was used to analyze the correlation of indicators and the area under receiver operator characteristic curves (AUROCs) of LSM, FIB-4, APRI and AAR were drawn according to liver biopsy pathology results as gold standard. The value of LSM, FIB-4, APRI and AAR diagnosing hepatic fibrosis in chronic HBV carriers was retrospectively analyzed. Retrospective analysis of FS, FIB-4, APRI and AAR were divided into 149 HBeAg-positive chronic HBV carriers (HBeAg-positive group) and 64 HBeAg-negative chronic HBV carriers (HBeAg) in 213 patients with chronic HBV carriers and HBeAg Negative group) in the diagnosis of liver fibrosis. Results: The LSM of 213 patients with chronic HBV carriers, 149 patients with HBeAg-positive chronic HBV carriers and 64 patients with HBeAg-negative chronic HBV carriers were significantly correlated with liver fibrosis grade≥ 2 (P < 0.001). Regardless of HBeAg status, only LSM in the three groups had moderate evaluation efficacy for evaluating significant fibrosis(S≥2), and the positive predictive value was more than 94%, but the diagnostic accuracy was not high, the minimum was 46.31% (HBeAg-positive group), the maximum value of 67.19% (HBeAg-negative group), while the remaining three kinds of serum noninvasive liver fibrosis diagnostic model indicators and diagnostic efficacy are low. The LSM in the three groups showed a significant positive correlation with liver fibrosis grade (S)≥2. Conclusion: LSM is more accurate than FIB-4, APRI and AAR in diagnosing chronic HBV carriers. Dynamically monitoring changes of LSM can earlier understand the progress of liver fibrosis than the three kinds of serology noninvasive diagnostic model and is contributed to the choice of liver biopsy timing.

Quantitative assessment of hepatic fibrosis in chronic hepatitis B and C: T1 mapping on Gd-EOB-DTPA-enhanced liver magnetic resonance imaging.

AIMTo assess the accuracy of Look-Locker on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for staging liver fibrosis in chronic hepatitis B/C (CHB/C).METHODSWe prospectively included 109 patients with CHB or CHC who underwent a 3.0-Tesla MRI examination, including T1-weighted and Look-Locker sequences for T1 mapping. Hepatocyte fractions (HeF) and relaxation time reduction rate (RE) were measured for staging liver fibrosis. A receiver operating characteristic analysis using the area under the receiver operating characteristic curve (AUC) was used to compare the diagnostic performance in predicting liver fibrosis between HeF and RE.RESULTSA total of 73 patients had both pathological results and MRI information. The number of patients in each fibrosis stage was evaluated semiquantitatively according to the METAVIR scoring system: F0, n = 23 (31.5%); F1, n = 19 (26.0%); F2, n = 13 (17.8%); F3, n = 6 (8.2%), and F4, n = 12 (16.4%). HeF by EOB enhancement imaging was significantly correlated with fibrosis stage (r = -0.808, P < 0.05). AUC values for diagnosis of any (≥ F1), significant (≥ F2) or advanced (≥ F3) fibrosis, and cirrhosis (F4) using HeF were 0.837 (0.733-0.913), 0.890 (0.795-0.951), 0.957 (0.881-0.990), and 0.957 (0.882-0.991), respectively. HeF measurement was more accurate than use of RE in establishing liver fibrosis staging, suggesting that calculation of HeF is a superior noninvasive liver fibrosis staging method.CONCLUSIONA T1 mapping-based HeF method is an efficient diagnostic tool for the staging of liver fibrosis.

Validation of Hepa-index as a non-invasive biomarkers panel for assessment of hepatic fibrosis in Egyptians with chronic hepatitis C.

Objectives:To validate the diagnostic performance of Hepa-Index in predicting different stages of hepatic fibrosis in Egyptian patients with chronic hepatitis C (CHC).Methods:Hundred treatment naïve chronic hepatitis C Egyptian patients were prospectively enrolled between June 2014 and January 2015. They were subjected to: platelet count, alpha-2-macroglobulin (α2-MG), total bilirubin, gamma glutamyl transpeptidase (GGT), total cholesterol, liver biopsy and histopathological staging of hepatic fibrosis according to METAVIR scoring system. Hepa-Index was calculated according to the formula: Hepa-Index=exp (-0.021 x platelet +1.65 x α2-MG+0.2 x total bilirubin + 0.026 x GGT -1.215 x total cholesterol) / (1+exp (-0.021 x platelet + 1.65 x α2-MG + 0.2 x total bilirubin +0.026 x GGT -1.215 x total cholesterol).Results:Hepa-Index correlates positively with the stage of hepatic fibrosis. Cut off values of Hepa-Index were: 0.2 for predicting significant hepatic fibrosis (≥F2 METAVIR), 0.3 for severe hepatic fibrosis (≥F3 METAVIR) and 0.4 for cirrhosis (F4 METAVIR). Hepa-Index was able to detect significant fibrosis with sensitivity of 69.4%, specificity of 76.3% and AUROC of 0.803. Hepa-Index was also able to detect severe hepatic fibrosis with sensitivity of 79.2%, specificity of 64.5% and AUROC of 0.783 and cirrhosis with sensitivity of 81.8%, specificity of 68.5% and AUROC of 0.744.Conclusion:Hepa-Index is a good non-invasive biomarkers panel that can be used for non-invasive assessment of hepatic fibrosis in chronic hepatitis C patients.

Fibrogenic/Angiogenic Linker for Non-Invasive Assessment of Hepatic Fibrosis Staging in Chronic Hepatitis C Among Egyptian Patients

Background and rationale for the studyLiver biopsy is the golden standard for staging liver fibrosis, but it may be accompanied by complications. Because of this complication, the aim of this study is to evaluate a simple noninvasive score to assess hepatic fibrosis in chronic hepatitis C genotype 4 patients which is very may have an important in diagnosis and therapeutic decision. This score [HA vascular (HAV) score] is a combination of direct markers [hyaluronic acid (HA) and vascular endothelial growth factor (VEGF)] and indirect markers [aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR)]. ResultsSamples were collected from 220 patients (F0-F4): an estimated group (n = 120) and a validated group (n = 100). HA and VEGF levels, HCV RNA, liver function tests, platelet counts were assayed, Fibroscan was done and liver biopsy was taken and the stage of liver fibrosis and the grade of inflammatory activity was calculated according to Metavir score system. HA vascular (HAV) score = -35.1 + 0.14 (HA) (ng/L) + 0.03 (VEGF) (pg/mL) + (-6.7) [AAR (AST/ALT ratio)]. The HAV score produced areas under curve of 0.979 and 0.994 for significant (F2-F4) and advanced fibrosis (F3-F4) (cut off = 0.583 and 6.3, respectively). Surprisingly, the validation study of this score gave very good values of AUCs i.e. 0.990, 0.996 and 0.995 for significant, advanced and liver cirrhosis. ConclusionsOur developed score can not only help to assess liver fibrosis staging effectively but also avoid the invasiveness and the limitations of liver biopsy in Egyptian hepatitis C virus patients.

METABOLIC FACTORS ASSOCIATED WITH HEPATIC STEATOSIS AND FIBROSIS IN CHRONIC HEPATITIS C PATIENTS.

28May 2017 METABOLIC FACTORS ASSOCIATED WITH HEPATIC STEATOSIS AND FIBROSIS IN CHRONIC HEPATITIS C PATIENTS. Ramy M ElSharkawy , GhadaMostafa K1 , Mahmoud Saif-Al-Islam Abd Elfatah , Eman Mohamed Salah-Eldein , Tamer Elmokadem , Ahmed Hassan and Hydi Ahmed. Departments of Tropical Medicine and Gastroenterology, Faculty of Medicine, SohagUniversity. Pathology, Faculty of Medicine, Sohag University. Microbiology and Immunology, Faculty of Medicine, Sohag University. Clinical Pathology,Faculty of Medicine, Sohag University and Ibn Sina National College, Jeddah,Saudi Arabia.

Serum microRNA-122 and Wisteria floribunda agglutinin-positive Mac-2 binding protein are useful tools for liquid biopsy of the patients with hepatitis B virus and advanced liver fibrosis.

BackgroundNoninvasive methods to accurately and conveniently evaluate liver fibrosis are desirable. MicroRNA (miR) is one of the candidates. MiRs are small RNAs consisting of 19–25 nucleotides that negatively regulate many target genes at transcriptional levels. Recently, many researchers have focused on circulating miRs in the blood stream as biomarkers. Hepatic miR-122 has been reported to have an association with viral replication and hepatic fibrosis in chronic hepatitis B virus (HBV) and hepatic C virus (HCV) infection.MethodsWe measured serum miR-122 levels in HBV- and HCV-infected patients confirmed with liver biopsy. We also investigated a novel liver fibrosis marker Wisteria floribunda agglutinin-positive Mac-2 binding protein [WFA(+)-M2BP]. We evaluated the diagnostic usefulness of these markers in hepatic fibrosis and inflammation of patients with chronic viral infection.ResultsThe serum miR-122 levels of HBV-infected patients were higher than those of the control subjects. In HBV-infected patients, the serum miR-122 levels of patients with advanced liver fibrosis were significantly lower. Serum WFA(+)-M2BP was significantly higher dependent on both the staging of fibrosis and the grading of inflammatory activity in patients with both HBV and HCV infection. We also observed that higher serum WFA(+)-M2BP levels augmented the prediction of advanced liver fibrosis among HBV-infected patients with lower serum miR-122 levels.ConclusionsA lower serum miR-122 level is a useful predictor of advanced liver fibrosis in HBV-infected patients. Serum WFA(+)-M2BP could predict liver fibrosis in both HBV and HCV infection. The combination of these markers may result in the more accurate evaluation of liver fibrosis in HBV infection.

Shear Wave Liver Elastography with a Propagation Map: Diagnostic Performance and Inter-Observer Correlation for Hepatic Fibrosis in Chronic Hepatitis

The aim of this study was to determine the performance of shear wave elastography (SWE) with a propagation map in the diagnosis of hepatic fibrosis, and to assess its reliability with transient elastography (TE) as the reference standard. Our prospective study included 115 consecutive patients with suspected or alleged chronic hepatitis. Patients underwent SWE by two different operators and TE by sonographers on the same day. The correlation coefficient of the intra-class correlation test between an experienced radiologist and a third-year radiology resident was 0.878. There was a moderate correlation between SWE and TE (r = 0.511) in the diagnosis of hepatic fibrosis. The best cutoff values predicting significant hepatic fibrosis and liver cirrhosis by SWE were >1.78 m/s (area under the receiver operating characteristic curve [AUROC] = 0.777) and >2.24 m/s (AUROC = 0.935), respectively. SWE with a propagation map is a reliable method for predicting hepatic fibrosis regardless of operator experience.

Platelet-derived growth factor A mRNA in platelets is associated with the degree of hepatic fibrosis in chronic hepatitis C.

Transforming growth factor beta 1 (TGFB1) and platelet-derived growth factor (PDGF) are the main cytokines related to hepatic fibrogenesis. RNA isolated from the platelets and hepatic tissue of 43 HCV carriers was used for quantitative polymerase chain reaction to determine TGFB1, PDGFA, and PDGFB RNA expression. The mRNA expression of PDGFA in platelets was significantly lower in the group with advanced fibrosis than in the group with early-stage fibrosis. TGFB1 was more frequently expressed in platelets than in hepatic tissue, which was different from PDGFB. A pathway mediated by overexpression of TGFB1 via PDGFA in megakaryocytes could be involved in the development of fibrosis.

Acoustic Radiation Force Impulse (ARFI) Elastography for non‑invasive evaluation of hepatic fibrosis in chronic hepatitis B and C patients: a systematic review and meta-analysis.

The purpose of the study was to assess the effect of Acoustic Radiation Force Impulse (ARFI) elastography in thediagnosis of liver fibrosis in chronic hepatitis B and C patients through Meta-analysis. Four databases(PubMed, the Cochrane Library, WanFang data, and CNKI) were searched. The key words were: ("ARFI" or "acoustic radiationforce impulse") combined with "liver fibrosis" and ("chronic hepatitis" or "HBV HCV"). Heterogeneity (I2) was assessed,and its source was analyzed through meta-regression. 21 articles with 2,691 patients were included. The compositeSe=0.79 (95% CI: 0.76-0.83) and Sp=0.86 (95% CI: 0.85-0.88). ARFI elastography showed a better ability to evaluate higherstageliver fibrosis and liver cirrhosis (F=3 and F=4, respectively). For F≥3, Se=0.84 (95% CI: 0.80-0.88, I2=61.37), Sp=0.90 (95% CI: 0.86-0.92, I2=65.10), and AUROC=0.94 (95% CI: 0.91-0.95). Se and Sp and AUROC of F=4 were 0.86 (95% CI:0.80-0.91, I2=70.67), 0.84 (95% CI: 0.80-0.88, I2=78.94) and 0.91 (95% CI: 0.89-0.94), respectively. Besides, the combined RFI values indicate that CHC patients had higher ARFI values especially in the F3 stage (1.87 [95% CI: 1.67-2.06] and 2.31[95% CI: 2.09-2.52] for CHB and CHC, respectively). ARFI elastography is accurate and reliable in the diagnosisof CHB- and CHC-induced liver fibrosis and is especially suitable for the evaluation of stages F≥3 and F=4. CHC patientsmanifest higher ARFI values than CHB patients especially in the F3 stage.

Shear Wave Liver Elastography with a Propagation Map: Diagnostic Performance and Inter-Observer Correlation for Hepatic Fibrosis in Chronic Hepatitis

Shear Wave Liver Elastography with a Propagation Map: Diagnostic Performance and Inter-Observer Correlation for Hepatic Fibrosis in Chronic Hepatitis

Evaluation of Serum Autotaxin as a Novel Noninvasive Marker for Assessment of Hepatic Fibrosis in Chronic Hepatitis C Patients

Evaluation of Serum Autotaxin as a Novel Noninvasive Marker for Assessment of Hepatic Fibrosis in Chronic Hepatitis C Patients

Infection with hepatitis viruses, FIB-4 index and risk of hepatocellular carcinoma in southern Italy: a population-based cohort study.

BackgroundThe incidence of hepatocellular carcinoma (HCC) and its association with hepatitis C (HCV) and hepatitis B virus (HBV) infections, FIB-4 index and liver enzymes was assessed in an area of the province of Naples covered by a population-based cancer registry.MethodsWe conducted a cohort investigation on 4492 individuals previously enrolled in a population-based seroprevalent survey on HCV and HBV infections. The diagnosis of HCC was assessed through a record linkage with the cancer registry. Hepatic metabolic activity was measured through serum alanine transaminase, aspartate aminotransferase, gamma-glutamyl-transferase, and platelet. The FIB-4 index was used as a marker of fibrosis. We computed HCC incidence rates (IR) for 100,000 (105) person-years of observation, and multivariable hazard ratios (HR) with 95 % confidence intervals (CI) to assess risk factors for HCC.ResultsTwenty two cases of HCC were diagnosed during follow-up (IR = 63.3 cases/105). Significantly increased HCC risks were documented in individuals with higher than normal liver enzymes and low platelet count; in the 239 HCV RNA-positives (HR = 61.8, 95 % CI:13.3–286); and in the 95 HBsAg-positives (HR = 75.0) –as compared to uninfected individuals. The highest FIB-4 score was associated with a 17.6-fold increased HCC risk.ConclusionsAn elevated FIB-4 index turned out to be an important predictor of HCC occurrence. Although the standard method to assess hepatic fibrosis in chronic hepatitis remains the histologic staging of liver biopsy specimen, the assessment of FIB-4 in HCV RNA-positive individuals may help in identifying the highest HCC-risk individuals who need anti-HCV treatment most urgently.

Comparison between Transient Elastography (FibroScan) and Liver Biopsy for the Diagnosis of Hepatic Fibrosis in Chronic Hepatitis C Patients

Transient elastography (TE) is gaining popularity as a non-invasive method for predicting liver fibrosis. The practical utility of the method is based on establishing cutoff values for each stage of fibrosis. A diagnosis of stage is based on measurements of liver stiffness that vary in different studies. The present study aimed to establish cutoff values for each stage of fibrosis to assess the performance of TE in fibrosis staging in Egyptian chronic HCV patients. This cross-sectional study was conducted at Specialized Medical Hospital and the Egyptian Liver Foundation, Mansoura, Egypt. The inclusioncriteria were: age older than 18 years and chronic infection by hepatitis C. The exclusion criteria were the presence of ascites, pacemaker or pregnancy. Three hundred and fifty six consecutive patients with chronic hepatitis C participated in the study. Liver fibrosis was staged according to the METAVIR system. The AUROCs for F2 or greater, F3 or greater and cirrhosis (F4) were 0.91 (95% CI 0.87 to 0.94), 0.95 (95% CI 0.91 to 0.99) and 0.97 (95% CI 0.96 to 0.99), respectively. ROC curve analysis identified optimal cutoff value of liver stiffness measurements as high as 9.8 kPa for F ≥ 2, 10.4 kPa for F ≥ 3, and 17.2 kPa for F = 4. The overall relation between fibrosis stages when comparing both FibroScan and biopsy was significant agreement between both (the kappa measure was 0.430 and p<0.001). TE is a good non-invasivetool for diagnosis and monitoring of liver fibrosis among patients with Chronic HCV infection.

CHRONIC HEPATITIS C

The major causative factor of hepatic cirrhosis and its complications in chronichepatitis C is due to presence of liver fibrosis. To assess prognosis and management relateddecisions, the exact staging of liver fibrosis is of greatest importance. Now, liver biopsyis the inexact gold standard for this purpose. APRI or AST to platelet ratio Index is the bestnoninvasive marker which can predict presence of fibrosis in majority of chronic hepatitis Cpatients without the need of biopsy. It is also cost effective and only depends on routine testing(Platelet count and serum AST). Objectives: To determine the positive predictive value ofAPRI Score for the prediction of fibrosis and cirrhosis in chronic hepatitis C patients. Studydesign: Cross sectional study. Setting: Medical wards and Out Patient Medicine Departmentof Liaquat University Hospital Hyderabad / Jamshoro. Period: 6 months. Methodology: A totalof 51 patients of either gender, age &gt;14 years presenting to Medical wards and OPD for theevaluation of chronic hepatitis were enrolled in this research study after giving preference andavoiding criteria. Clinical data was collected at the time of liver biopsy and blood samples forliver function tests, blood glucose and complete blood picture with platelet count were collectedbefore the biopsy (only AST and platelet count are needed for APRI score) a core biopsy needleof 14 gauge was used and the procedure was conducted under ultrasound guidance. Fibrosisstage was determined according to the METAVIR group scoring system. The patients wereexamined in a very comfortable manner and all the information collected from the patients waskept confidential and entered in the predesigned proforma. Results: A total of 51 patients wereselected for this study. Out of these 31 (60.78%) were male and 20(39.22%) were female. Themean age was 42.53 years (±11.2 SD). The positive predictive value for APRI score between0.5 to 1.0 was 58.82% whereas the positive predictive values for APRI score 1.1-1.5 was 70.58%.Conclusion: The positive predictive values of APRI score in the ranges of 0.5 to 1.5 were notindicative of the presence of significant liver fibrosis in this research study. However, additionaldata are required to authenticate or disprove the usefulness of APRI score for the prediction ofsignificant hepatic fibrosis in chronic hepatitis C patients.

English

The major causative factor of hepatic cirrhosis and its complications in chronichepatitis C is due to presence of liver fibrosis. To assess prognosis and management relateddecisions, the exact staging of liver fibrosis is of greatest importance. Now, liver biopsyis the inexact gold standard for this purpose. APRI or AST to platelet ratio Index is the bestnoninvasive marker which can predict presence of fibrosis in majority of chronic hepatitis Cpatients without the need of biopsy. It is also cost effective and only depends on routine testing(Platelet count and serum AST). Objectives: To determine the positive predictive value ofAPRI Score for the prediction of fibrosis and cirrhosis in chronic hepatitis C patients. Studydesign: Cross sectional study. Setting: Medical wards and Out Patient Medicine Departmentof Liaquat University Hospital Hyderabad / Jamshoro. Period: 6 months. Methodology: A totalof 51 patients of either gender, age &gt;14 years presenting to Medical wards and OPD for theevaluation of chronic hepatitis were enrolled in this research study after giving preference andavoiding criteria. Clinical data was collected at the time of liver biopsy and blood samples forliver function tests, blood glucose and complete blood picture with platelet count were collectedbefore the biopsy (only AST and platelet count are needed for APRI score) a core biopsy needleof 14 gauge was used and the procedure was conducted under ultrasound guidance. Fibrosisstage was determined according to the METAVIR group scoring system. The patients wereexamined in a very comfortable manner and all the information collected from the patients waskept confidential and entered in the predesigned proforma. Results: A total of 51 patients wereselected for this study. Out of these 31 (60.78%) were male and 20(39.22%) were female. Themean age was 42.53 years (±11.2 SD). The positive predictive value for APRI score between0.5 to 1.0 was 58.82% whereas the positive predictive values for APRI score 1.1-1.5 was 70.58%.Conclusion: The positive predictive values of APRI score in the ranges of 0.5 to 1.5 were notindicative of the presence of significant liver fibrosis in this research study. However, additionaldata are required to authenticate or disprove the usefulness of APRI score for the prediction ofsignificant hepatic fibrosis in chronic hepatitis C patients.

Role of fibroscan, TGF-β1, and YKL-40 in the detection of hepatic fibrosis in chronic hepatitis c patients with and without schistosomiasis

Role of fibroscan, TGF-β1, and YKL-40 in the detection of hepatic fibrosis in chronic hepatitis c patients with and without schistosomiasis

Serum hyaluronic acid as a noninvasive marker of hepatic fibrosis in chronic hepatitis c patients

Background Patients with chronic hepatitis C virus (HCV) infection are often asymptomatic with few clinical signs of liver disease. Recognition of the presence of fibrosis or cirrhosis is difficult without liver biopsy, but with the availability of effective treatments, such as interferon, and the potential for progression to hepatoma in some cases, an accurate measure of the stage of disease is important. Serum hyaluronic acid (HA) has been identified as a potential marker of fibrosis or cirrhosis. Aim of the work The aim of this study was to evaluate the serum level of HA as a noninvasive marker of hepatic fibrosis in comparison with liver biopsy and indirect serum fibrosis markers such as AST/ALT ratio and aspartate transaminase to platelet ratio index (APRI) in chronic HCV patients. Patients and methods Our patients were classified into three groups: group 1 included 20 patients with mild hepatic fibrosis (F1 stage); group 2 included 20 patients with moderate hepatic fibrosis (F2 stage); and group 3 included 20 patients with marked hepatic fibrosis and cirrhosis (F3 and F4 stages). The control group included 20 normal volunteers. Serum HA level evaluation, liver function tests, and complete blood count were carried out for all groups, whereas liver biopsy was performed only for patients to determine the stage of liver fibrosis. Results There was a highly significant increase in serum HA level in group 2 and group 3 in comparison with the control group and a significant increase in group 1 in comparison with the control group. However, there was highly significant increase in group 3 in comparison with group 1 and group 2 and a significant increase in group 2 in comparison with group 1. The cutoff point for HA level was greater than 42.18 ng/l to discriminate between the patient and the control group, with a sensitivity of 91.7% and a specificity of 95.0% for HA. The cutoff point for HA level was greater than 81.68 ng/l to discriminate between group 1 (mild fibrosis) and group 2 (moderate fibrosis), with a sensitivity of 100% and a specificity of 70%. The cutoff point for HA level to discriminate between group 2 (moderate fibrosis) and group 3 (severe fibrosis and cirrhosis) was greater than 167.98 ng/l, with a sensitivity of 90% and specificity of 80%. There was a significant positive correlation between serum HA level and APRI. Conclusion HA is a promising reliable simple noninvasive marker for assessing liver fibrosis in HCV-infected patients with high sensitivity and specificity. There was a positive correlation between serum HA level with stages of hepatic fibrosis and APRI.

Evaluation of APRI and FIB-4 scoring systems for non-invasive assessment of hepatic fibrosis in chronic hepatitis B patients

While the gold standard in the assessment of liver fibrosis remains liver biopsy, non-invasive methods have been increasingly used for chronic hepatitis B (CHB). This study aimed to evaluate the performance of two commonly used non-invasive scoring systems (aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4)) to predict fibrosis stage in CHB patients. Demographic, histologic and clinical laboratory data from two trials investigating tenofovir disoproxil fumarate in CHB were analyzed. Predicted fibrosis stage, based on established scales and cut-off values for APRI and FIB-4 scores, was compared with Ishak scores obtained from liver biopsy at baseline and at 240 week follow-up. In the 575 patients with a baseline liver biopsy, APRI and FIB-4 scores correlated with Ishak stage (p<0.01); however extensive overlap in the distribution of both scores across Ishak stages prevented accurate determination of fibrosis. The majority (81-89%) of patients with advanced fibrosis or cirrhosis were missed by the scores. Similarly, 71% patients without fibrosis were misclassified as having clinically significant fibrosis. APRI and FIB-4 scores at week 240 tended to be low and underestimate fibrosis stage in the patients with liver biopsies after 240 weeks of therapy. APRI or FIB-4 reduction did not correlate with fibrosis regression after 240 weeks of antiviral therapy. APRI and FIB-4 scores are not suitable for use in clinical practice in CHB patients for assessment of hepatic fibrosis according to Ishak stage, especially in gauging improvements in liver fibrosis following therapy.

Fibrosis index based on four factors better predicts advanced fibrosis or cirrhosis than aspartate aminotransferase/platelet ratio index in chronic hepatitis C patients.

Liver biopsy is the gold standard to determine the severity of hepatic fibrosis despite its risk and invasiveness. The aspartate aminotransferase/platelet ratio index (APRI) could noninvasively predict the severity of hepatic fibrosis in chronic hepatitis C (CHC) patients. Whether fibrosis index based on four factors (FIB-4) could better predict the severity of hepatic fibrosis than APRI in CHC patients remains inconclusive. This retrospective study enrolled 1473 CHC patients (784 men and 689 women) with liver biopsy and clinical data including age, aspartate aminotransferase, alanine aminotransferase, and platelet count. FIB-4 and APRI were calculated with a formula using the four clinical parameters. Hepatic fibrosis was staged using the Metavir classification system. The areas under the receiver operating characteristics of FIB-4 for the diagnosis of significant fibrosis (≥ F2), advanced fibrosis (≥ F3), and cirrhosis (F4) were 0.816 [95% confidence interval (CI), 0.795-0.836], 0.827 (95% CI, 0.806-0.849), and 0.849 (95% CI, 0.830-0.867), respectively, compared with those of APRI-0.799 (95% CI, 0.778-0.819), 0.791 (95% CI, 0.770-0.812), and 0.802 (95% CI, 0.781-0.922). In addition, the areas under the receiver operating characteristics of FIB-4 were significantly greater than those of APRI for patients with advanced fibrosis and cirrhosis, respectively (p < 0.0001). FIB-4 could predict hepatic fibrosis in CHC patients. By adding two parameters (age and alanine aminotransferase), FIB-4 better predicts advanced fibrosis and cirrhosis than APRI in CHC patients.

Role of fibroscan, TGF-β1, and YKL-40 in the detection of hepatic fibrosis in chronic hepatitis c patients with and without schistosomiasis

ObjectiveThe aim of this study was to compare the efficacy of transient elastography, the direct fibrogenic markers YKL-40, and transforming growth factor β (TGF-β1) alone or in combination versus liver biopsy for detecting the stage as well as the progression rates of hepatic fibrosis in patients w