APRI test and hyaluronic acid as non-invasive diagnostic tools for post HCV liver fibrosis: systematic review and meta-analysis

Background and study aims: Hepatitis C virus [HCV] accounts for a sizable proportion of chronic liver disease cases and represents the most common indication for liver transplantation. Precise diagnosis of hepatic fibrosis stage is considered a funnel-neck in proper management and follow-up of HCV-infected patients. Given the possible complications of liver biopsy, a non-invasive method for assessing hepatic fibrosis is needed. This study aimed to evaluate the diagnostic accuracy of APRI and hyaluronic acid as non-invasive diagnostic assessment tools for post HCV liver fibrosis

Patients and methods: Systematic literature searching identified studies performed on Egyptian territory to evaluate APRI and hyaluronic acid as non-invasive tests of fibrosis and using liver biopsy as the reference standard. Meta-analysis was performed for areas with an adequate number of publications. Validation of meta- analysis on APRI was done on a subset of 150 treatment-naive post-hepatitis C patients

Results: Both APRI and hyaluronic acid have superior predictive power for hepatic cirrhosis [F4] than for significant fibrosis [F2-F3]. The pooled estimate for sensitivities and specificities of APRI and hyaluronic acid to diagnose F4 were [84% and 82%] and [83% and 89%] respectively. In the subgroup of treatment naive post-hepatitis C patients, APRI had higher diagnostic performance to diagnose liver cirrhosis with 93.8% sensitivity and 72.4% specificity [AUC; 0.908, 95% CI; 0.851-0.965, p-value; <0.001] compared to its accuracy to diagnose significant hepatic fibrosis with 65.1% sensitivity and 77.8% [AUC; 0.685, 95% CI; 0.59-0.78, p-value; 0.001]

Conclusion: APRI score and hyaluronic acid levels are simple and reliable non-invasive markers to detect advanced fibrosis among post-hepatitis C patients

Detection of ascitic fluid infections in patients with liver cirrhosis and ascites

Ascitic fluid infections [AFIs] are the frequent complications of advanced liver disease. Bacterial translocation is considered a key step in the pathogenesis of gut-derived bacterial infections; mainly spontaneous bacterial peritonitis [SBP] in cirrhotic patients. Bacterial DNA [bactDNA] in ascitic fluid and serum has been suggested as a surrogate marker for bacterial translocation. We attempted at the isolation and identification of bacteria in ascitic fluid in cirrhotic patients and the assessment of polymerase chain reaction [PCR] in ascitic fluid and serum. Fifty cirrhotic patients having ascites with no signs of infection were included. Ascitic fluid cultures were obtained from patients. Ascitic fluid and serum were subjected to DNA extraction and PCR for the universal amplification of a region of the 16S ribosomal RNA [16S rRNA] gene to detect bactDNA. Bacteria were isolated from 9 [18%] of the ascitic fluid samples, and were mainly Gram-positive bacteria. BactDNA was detected simultaneously in the ascitic fluid and serum of 17 [34%] patients and in the ascitic fluid of only 2 patients. In a single patient with positive ascitic fluid culture no bactDNA was detected in ascitic fluid or serum. By considering AFIs as a positive ascitic fluid culture and/or the presence of bactDNA in the ascitic fluid and/or serum, ascitic fluid culture could detect 9 out of 20 patients with AFIs [45%], PCR of ascitic fluid could detect 19 out of 20 [95%] while PCR of serum could detect 17 out of 20 [85%]. In 10 patients with culture negative non-neutrocytic ascites [CNNNA] bactDNA could be detected in serum and ascitic fluid. AFI can be caused by Gram positive as well as Gram negative organisms. A substantial percentage of cases with CNNNA show bactDNA in serum and ascitic fluid. PCR of ascitic fluid should, therefore, be used in the diagnostic workup of suspected cases of ascitic fluid infections

Quality of life of Egyptian donors after living-related liver transplantation

Quality of life after liver donation must remain a primary outcome measure when we consider the utility of living donor liver transplants. In making clinical decisions on the use of transplantation for chronic liver diseases, consideration should be given to the key factors likely to affect subsequent health related quality of life. It would be beneficial for donors, if factors predicting good quality of life are identified. The aim of this study was to assess the health related quality of life changes experienced by donors following living related liver transplantation using the Short Form 36 [SF-36] questionnaire. Between August 2001 and December 2006, 125 adults received liver grafts from living donors at Dar Al-Fouad Hospital, Cairo, Egypt. The SF-36v2 questionnaire was applied to 30 donors after at least 6 months following donation and maximally 4 years after donation [mean +/- SD:3.28 +/- 1.56 years]. Furthermore, 30 healthy volunteers were taken as a control group. None of the donors required re-surgery and no deaths were reported. Only 4 [13.3%] donors experienced minor complications, which did not affect their quality of life and had no long term effects. No significant difference was found between donors and control group when means of the Physical and Mental Component Summary were compared. The physical functioning domain was the only domain of health which showed a statistically significant difference between both groups. Health related quality of life of donors was not compromised after full recovery. All donors had good recovery and returned to regular activities within 2-4 months post donation