Comparison and validation of laminin-based score and fibroscan for prediction of liver fibrosis in Egyptian patients with chronic hepatitis C

The constraints of liver biopsy and the limitations of single parameters in assessing liver fibrosis have boosted the development of scores combining markers to improve accuracy. Laminin-based score was devised by the study group in 2006. The present study was conducted to validate the diagnostic accuracy of this score and of transient elastography [T.E.] In another group of ninety Egyptian patients with chronic hepatitis C. Patients were biopsied and subjected to assessment of score parameters [serum albumin, AST, prothrombin concentration, laminin, portal vein diameter] and liver stifihess by T.E. Patients were classified using modified Knodell score into 7 groups [stage 0-stage 6]. A significant relation between the stage of fibrosis and the laminin-based score was found. The score demonstrated high accuracy for diagnosing significant fibrosis and cirrhosis. Liver stiffness correlated significantly with staging of fibrosis as well as with laminin-based score. T.E. demonstrated high accuracy for diagnosing significant fibrosis and cirrhosis. Both methods proved useful to discriminate stages F4 and F5. When both methods were combined, the diagnostic accuracy was increased to 93.7% for diagnosing significant fibrosis. Laminin-based score and T.E. Proved their clinical value and may reduce the need for repeated liver biopsies

Prognostic significance of hepatic veins waveforms study by doppler ultrasonography in cirrhotic patients with portal hypertension

Doppler Ultrasonographic [U/S] waveform changes in the hepatic veins can be found in chronic parenchymal liver disease, especially in the late stages. In this prospective study, 150 Egyptian bilharzial cirrhotic patients with portal hypertension but without hepatocellular carcinoma [HCC] in addition to 20 age and sex matched apparently healthy control were studied. Diagnosis was confirmed with liver biopsy in 121 patients [those with prolonged prothrombin time 3 seconds more than control and platelet count less than 90000 per mm were excluded]. Doppler wave form patterns in patients were classified into 4 types: [I, II, III and IV], while we found that all the control group was of type I Doppler waveform Prognostic value of the hepatic veins waveforms together with clinical and biochemical parameters were evaluated with their relation to the outcome of our patients. Out of 150 of our patients 112 were male and 38 were females, their ages ranged between 29-65 years [with mean +/- SD = 47.08 +/- 7.70 years]. All were experienced variceal bleeding. Most of the patients [130] were HCV positive. By the end of the follow up period [18 months] 23 [15:3%] patients have died, all due to liver cell failure. A univariate analysis that followed by a multivariate one showed that flat Doppler waveform [type IV] changes in the right hepatic vein with the following characteristics of patients [rebleeding varices, presence of encephalopathy, increase s.billrubin and decrease prothrombin%] were independently related to survival. Doppler U/S study [which is a non-invasive maneuver] of the right hepatic vein has improved the prognostic accuracy in patients with cirrhosis and portal hypertension. Moreover type IV [flat waveform with fluttering] was associated with bad prognosis and poor survival