ABSTRACT
Background and study aim: transient elastography is widely used to assess fibrosis stage in chronic hepatitis C [CHC]. We aimed to establish and validate different transient elastography cut-off values for significant fibrosis and cirrhosis in CHC genotype 4 patients
Patients and Methods: the data of 100 treatment-naive CHC patients [training set] and 652 patients [validation set] were analysed. The patients were subjected to routine pretreatment laboratory investigations, liver biopsy and histopathological staging of hepatic fibrosis according to the METAVIR scoring system. Transient elastography was performed before and in the same week as liver biopsy using FibroScan [Echosens, Paris, France]. Transient elastography results were correlated to different stages of hepatic fibrosis in both the training and validation sets
Results: ROC curves were constructed. In the training set, the best transient elastography cut-off values for significant hepatic fibrosis [>/=F2 METAVIR], advanced hepatic fibrosis [>/=F3 METAVIR] and cirrhosis [F4 METAVIR] were 7.1, 9 and 12.2 kPa, with sensitivities of 87%, 87.5% and 90.9% and specificities of 100%, 99.9% and 99.9%, respectively. The application of these cut-offs in the validation set showed sensitivities of 85.5%, 82.8% and 92% and specificities of 86%, 89.4% and 99.01% for significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis, respectively
Conclusion: transient elastography performs well for significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis, with validated cut-offs of 7.1, 9 and 12.2 kPa, respectively, in genotype 4 CHC patients
ABSTRACT
Elevated levels of alpha-fetoprotein [AFP] can be seen in patients with chronic hepatitis C [CHC] and liver cirrhosis without hepatocellular carcinoma and were negatively associated with treatment response. However, factors associated with its changes are not identified. We aimed in this study to verify a cut-off value for AFP as a predictor of response to standard of care [SOC] antiviral therapy in Egyptian chronic hepatitis C virus [HCV]-infected patients and identify factors associated with its changes post treatment. A total of 175 chronic non-cirrhotic HCV-infected patients were evaluated for baseline serum AFP and liver biopsy were classified according to Ishak scoring system of hepatic fibrosis. All patients were scheduled to receive SOC antiviral therapy for 48 weeks and had been followed up to week 72. Reassessment of AFP and repeated liver biopsy at week 72 were feasible only in 79 patients. High baseline AFP levels were observed in non-respondents [non-sustained virological respondents [non-SVRs]] [P< 0.01]; the AFP level decreased in all patients post treatment [P= 0.01], especially in the SVRs [P < 0.01]. In multivariate analysis, hepatic fibrosis was a predictor of response to treatment [P=0.02], while body mass index [BMI] [25-30 kg mr[2]], hepatic activity [A2], hepatic fibrosis stage [F2-F4] and fibrosis improvement were predictors of AFP difference [P = 0.007, 0.01, 0.012, <0.001, 0.030, and 0.018], respectively. The diagnostic performance to predict the HCV treatment response was best by adding both AFP and hepatic fibrosis stage factors; the best cut-off value for AFP was 3.57 ng dr1 with 50% sensitivity and 68% specificity with area under the curve [AUC] of 0.55 and for hepatic fibrosis stage was 3, with a sensitivity of 88%, a specificity of 30% with an AUC of 0.58. In chronic HCV-infected patients, serum AFP below 3.57 ng dl[-1] and hepatic fibrosis stage 3 are expected to have good response to treatment; BMI [25-30 kg m[-1]], A2, fibrosis >2 and fibrosis improvement predict AFP change post treatment