The diagnostic value of indirect markers of liver fibrosis in patients with chronic hepatitis B
https://doi.org/10.22625/2072-6732-2020-12-1-73-79
Abstract
Aim of investigation: The aim of the present study was to evaluate the possibility using of indirect liver fibrosis markers for the estimation of fibrosis severity and timely prescribing of antiviral therapy in patients with chronic hepatitis B.
Materials and methods: We examined 130 patients with chronic hepatitis B (mean age 41,8±13,5 years, 70% of men) having known liver fibrosis stage based on fibroelastography or liver biopsy. The age of patients, 9 parameters of biochemical blood analysis, complete blood count and coagulogram along with 7 indices calculated on their base were considered. Their prognostic values were estimated by means of ROC analysis.
Results: According to increase of liver fibrosis stage albumin, prothrombin index, platelet count, cholesterol reduce and aspartate aminotransferase, international normalized ratio, gamma-glutamyl transpeptidase, alanine aminotransferase, alkaline phosphatase levels rise (p<0,01). All of the laboratory parameters and indices were significantly different (p<0,01) in patients with minimal (F0–F1) and advanced (F2–F4) fibrosis. For patients with chronic hepatitis B the most significant predictors of advanced liver fibrosis (F2–F4) were: GUCI and King’s score indices as well as eLIFT scale. Index GUCI had the best diagnostic performance (area under the receiver operating characteristic curve 0,866) with 89,5% sensitivity and 78,0% specificity at cut off ≥0,7/
Conclusion: The assessment of indirect liver fibrosis markers in patients with chronic hepatitis B can be easily performed at any stage of medical care; they are quite informative and can be used for the estimation of fibrosis severity and timely conducting antiviral therapy.
About the Authors
D. V. Tereshkov
Gomel Regional Infectious Clinical Hospital
Belarus
Gomel
Belarus
Gomel
V. M. Mitsura
Gomel State Medical University
Belarus
Gomel
Belarus
Gomel
References
1. Global Hepatitis Report 2017. Geneva: World Health Organization, 2017 https://www.who.int/hepatitis/publications/ global-hepatitis-report2017/en/
2. Stanaway J.D., Flaxman A.D., Naghavi M., Fitzmaurice C., Vos T., Abubakar I., et al. The global burden of viral hepatitis from 1990 to 2013: εndings from the global burden disease study 2013. Lancet 2016;388:1081–1088. https://doi.org/10.1016/ S0140-6736(16)30579-7
3. Trautwein C., Friedman S.L., Schuppan D., Pinzani M. Hepatic fibrosis: Concept to treatment. J Hepatology 2015;62:15– 24. https://doi.org/10.1016/j.jhep.2015.02.039
4. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. Geneva: WHO, 2015 – 166 p. https://www.who.int/hepatitis/publications/hepatitisb-guidelines/en/
5. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatology 2017;67:370– 398. https://doi.org/10.1016/j.jhep.2017.03.021
6. EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatology 2015;63:237–264. https://doi.org/10.1016/j. jhep.2015.04.006
7. Papastergiou V., Tsochatzis E., Burroughs A.K. Non-invasive assessment of liver fibrosis. Ann Gastroenterol 2012;25(2):218-231. https://www.ncbi.nlm.nih.gov/ pubmed/24714123
8. Sheptulina A.F., Shirokova Y.N., Ivashkin V.T. Non-invasive of liver fibrosis diagnostics: the role of serum markers. Russian Journal of Gastroenterology, Hepatology, Coloproctology 2015;2:28–40 (In Russian).
9. Castera L. Noninvasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology 2012;142(6):1293–1302. https://doi.org/10.1053/j.gastro.2012.02.017
10. Castera L. Hepatitis B: are non-invasive markers of liver fibrosis reliable? Liver Int 2014;34 (Suppl. 1):91–96. https:// doi.org/10.1111/liv.12393
11. Fedorov P.N., Belyakov N.A. Laboratory markers of liver fibrosis. Medical academic journal 2014;14(1):16–23 (In Russian). https://rucont.ru/efd/614205
12. Giannini E., Risso D., Botta F., Chiarbonello B., Fasoli A., Malfatti F., Romagnoli P., Testa E., Ceppa P., Testa R. Validity and clinical utility of the aspartate aminotransferase-alanine aminotransferase ratio in assessing diasease severity and prognosis in patients with hepatitis C virus-related chronic liver disease. Arch Intern Med 2003;163:218–224. https://doi:10.1001/ archinte.163.2.218
13. Wai C.T., Greenson J.K., Fontana R.J., Kalbfleisch J.D., Marrero J.A., Conjeevaram H.S., Lok A.S. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003;38:518–526. https://doi.org/10.1053/jhep.2003.50346
14. Sterling R.K., Lissen E, Clumeck N., Sola R., Correa M.C., Montaner J., Sulkowski M.S., Torriani F.J., Dieterich D.T., Thomas D.L., Messinger D., Nelson M. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006;43(6):1317–1325. https://doi.org/10.1002/hep.21178
15. Xiao G., Yang J., Yan L. Comparison of diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis-4 index for detecting liver fibrosis in adult patients with chronic hepatitis B virus infection: a systemic review and meta-analysis. Hepatology 2015;61(1):292–302. https://doi. org/10.1002/hep.27382
16. Islam S, Antonsson L, Westin J, Lagging M. Cirrhosis in hepatitis C virus-infected patients can be excluded using an index of standard biochemical serum markers. Scand J Gastroenterol 2005;40:867-872. https://doi.org/10.1080/00365520510015674
17. Gudowska M., Gruszewska E., Panasiuk A., Cylwik B., Swiderska M., Flisiak R., Szmitkowski M., Chrostek L. Selected noninvasive markers in diagnosing liver diseases. Laboratory Medicine 2016;47(1):67–72. https://doi:10.1093/labmed/ lmv015
18. Cross T.J., Rizzi P., Berry P.A. King’s Score: an accurate marker of cirrhosis in chronic hepatitis C. European J Gastroenterol Hepatol 2009;21(7):730–738. https://doi:10.1097/ MEG.0b013e32830dfcb3.
19. Marpaung Y.A., Sembiring J., Zain L.H. Accuracy of liver fibrosis degree based on King’s score to Fibroscan in chronic hepatitis B. Indonesian J Gastroenterol Hepatol Digestive Endoscopy 2016;17(1):10–15. https://doi.org/10.24871/171201610-15
20. Boursier J., de Ledinghen V., Leroy V., Anty R, Francque S., Salmon D., Lannes A., Bertrais S., Oberti F., Fouchard-Hubert I, Calès P. A stepwise algorithm using an at-a-glance firstline test for the non-invasive diagnosis of advanced liver fibrosis and cirrhosis. J Hepatology 2017;66:1158–1165. https://doi. org/10.1016/j.jhep.2017.01.003
21. Zhou K., Gao C.-F, Zhao Y.-P., Liu H.-L., Zheng R.-D., Xian J.-C., Xu H.-T., Mao Y.-M., Zeng M.-D., Lu L.-G. Simpler score of routine laboratory tests predicts liver fibrosis in patients with chronic hepatitis B. J Gastroenterol Hepatol 2010;25:1569– 1577. https://doi:10.1111/j.1440-1746.2010.06383.x
Review
For citations:
Tereshkov D.V., Mitsura V.M. The diagnostic value of indirect markers of liver fibrosis in patients with chronic hepatitis B. Journal Infectology. 2020;12(1):73-79. (In Russ.) https://doi.org/10.22625/2072-6732-2020-12-1-73-79
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