Non-Invasive Markers for Liver Fibrosis in Chronic HCV Patients
Assistant Professor of Tropical Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Background and aim: – Liver biopsy for years was the only trustable tool for liver cirrhosis evaluation, it is an invasive and painful procedures with considerable rate of complications. Looking for non-invasive markers was mandatory.
We aimed to evaluate the use of non-invasive markers for fibrosis staging in HCV-infected patients.
Patient and methods: – From HCV patients subjected to antiviral therapy within 2014, 42 patients were evaluated with histopathological staging (metavir-staging) after liver biopsy. According to pathological stages, our patients were divided into; group-I of 18 patients with significant liver fibrosis and group-II of 24 patients of non-significant liver fibrosis.
For all patient age, ALT, AST, GGT, cholesterol, platelets count, bilirubin, prothrombin time and albumin were evaluated and statistically correlated with fibrosis stage.
Results: – Patients with significant liver fibrosis had higher AST and GGT levels and lower S. Albumin and prothrombin time than patient without significant liver fibrosis.
Patients with significant liver fibrosis had positive correlation between AST and GGT level and stage of fibrosis, also had negative correlation S. Albumin, platelet count and prothrombin time and stage of fibrosis.
Conclusion: – non-invasive markers as AST, GGT, serum albumin, platelet count and prothrombin time could be used as markers for diseases severity in cirrhotic patients of HCV.
Recommendation: – Recent study for evaluating these markers before and after HCV therapy is highly recommended.
Keywords: – HCV; Hepatitis C virus, Liver biopsy and Liver Fibrosis
In our area 15 %-17% of the general population found to be chronically infected with hepatitis C.1 Chronic HCV is the most prevalent disease in hepatology clinics. Generally, it was accepted that the diagnostic protocol of HCV includes a liver biopsy. Liver biopsy is an invasive and painful procedures which has rare but potentially life- threatening complication.2&3
The prognosis and management of chronic liver disease greatly depends on the degree and progression of liver fibrosis. Liver fibrosis staging provides prognostic information3,4&5.
The accuracy of liver biopsy in assessing liver fibrosis has also been questioned.4
Other tests as procollagen III, serum hyaluronate, N-peptide, laminin, type IV collagen matrix, laminin, metalloproteinase tissue inhibitory metalloproteinase-1, transforming growth factor – beta, platelets count, prothrombin index, and aspartate aminotransferase (AST), alanin aminotransferase (ALT) ratio >1, from a clinical standpoint had been used for diagnosis of liver fibrosis.6
Forns and colleagues reported a fibrosis index based on Age, Platelet count, Gamma –GT, and Cholesterol levels.4
Patients and Methods: –
This study was rolled on 42 patients with chronic HCV subjected to liver biopsy between January 2014 and December 2015 before Sofosbuvir -based antiviral therapy. This study was performed at Al-Hussein university hospital. Clear written consent, full clinical evaluation, laboratory and sonographic findings were recorded.
After liver biopsy, the examined patients were divided into 2 groups, group-I of 18 patients with liver fibrosis and group-II of 24 patients of non-fibrotic liver.
Liver fibrosis was accepted to be significant it comes in stages 2,3 or 4) but if not, it seems to be absent (stage 0 or 1 respectively).4
Sixty-five-year-old patients or older, alcohol addict, morbidly obese, co-infected with HBV andor HIV were excluded.
Histological staging: – Ultrasonogrphic–guided liver biopsy was performed after patient written informed consent. Specimens were fixed, paraffin–embedded and stained with hematoxilin and eosin, A minimum of 6 portal tracts in the specimen were required for diagnosis. All liver biopsies samples were evaluated by the same histopathologist.
Statistical analysis: –
Data entry and statistical analysis were performed using the statistical package for social sciences, version 20 (SPSS Inc., Chicago, Illinois, USA). Independent-samples t-test of significance was used when comparing between two means. Pearson’s correlation coefficient (r) test was used for correlating data, r value ;+0.20 means positive correlation, ;-0.20 means negative correlation and from -0.20 to +0.20 means no or negligible relation.
Table 1:- Baseline characteristics of studied patients
Characteristics Group-I (18) Group-II (24) t P
Age (y) M+SD 35.11+15.1 33.75+14.5 0.295 ;0.05
AST (IU/L); 40 69.5+58.9 40.2+33.3 2.05 * 40 63.5+60.6 52.9+30.2 0.746 ;0.05
GGT(IU/L) 79.9+69.4 41.3+24.9 2.53 * 1.2 3.43+3.39 1.2+1.38 1.69 ;0.05
Choles. (mg/dL) ;200 218+150 200+135 0.119 ;0.05
Albumin. (g/L) ; 3.5 2.45+1.7 3.78+1.5 2.09 *15 16.6+4.5 12.9+2.3 2.12 *