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

Correlation of ultrasonographic findings with histopathological diagnosis in HCV related chronic liver diseases

Hepatitis C virus is a major cause of chronic liver disease worldwide, it is estimated that 1% of the world's population may be infected with hepatitis C. Egypt has the highest countrywide prevalence of hepatitis C virus in the world, with an estimated 8-10 million have been exposed to the virus and 5-7 million have active infection. Over 80% of acutely infected patients go on to develop chronicity but only 20% to 25% will develop end stage liver disease and complications. Liver biopsy has been recommended to exclude other liver diseases and to establish a histological stage and grade of liver disease. This provides an important clue for management and potentially for prognosis of chronic hepatitis C. conventional transabdominal ultrasonography is accurate in predicting the final diagnosis in patients with compensated chronic liver disease and may identify cirrhosis in different cases. This study was designed to confirm the diagnostic accuracy of ultrasonography to detect early changes of liver cirrhosis in chronic hepatitis C patients. The study included 80 patients with HCV related compensated chronic liver disease; All patients were subjected to full clinical assessment, laboratory tests, HB markers, HCV Abs, PCR for HCV, conventional transabdominal ultrasonongraphy, with duplex Doppler examination and histopathological examination of liver biopsy specimens using modified [Knodell] Histologic Activity index [HAI] score. The study included 80 patients with chronic liver disease, with a male to female ratio of 4:1. Dental manipulation, previous surgery, and parentral antischistosomal therapy were the most common risk factors. A significant positive correlation was present between the right lobe in mid clavicular line and hisologic activity index [HAI], and a negative correlation between hepatic artery resistive index [HARI] and HAI. A highly positive correlation between the liver surface and fibrosis stage and a negative correlation between portal vein peak velocity and the fibrosis stage. A significant positive correlation between bright liver, the size of the left lobe in midline, quadrate lobe transverse diameter, splenic sizes and hepatoduodenal lymph nodes on ultrasonography and steatosis grade. In conclusion abdominal ultrasonography together with duplex Doppler examination is an accurate method in detecting early changes of liver cirrhosis in chronic liver disease