Serum connective tissue markers as predictors of advanced fibrosis in patients with chronic hepatitis B and D.

BACKGROUND/AIMS: Liver biopsy to assess fibrosis is invasive and prone to sampling error. While algorithms of serum markers to predict fibrosis stage have been described for chronic hepatitis C, these cannot be applied equally well to hepatitis B. METHODS: We therefore determined 9 serum fibrosis markers, liver biochemical tests and ultrasound parameters in 109 consecutive adult patients with chronic hepatitis B and D. All patients had compensated liver disease. Using the METAVIR score, advanced disease was defined as fibrosis stage ≥F2, and active inflammation as grade ≥A2. A gold standard was created considering splenomegaly and/or platelets <150,000 as indicators of advanced fibrosis irrespective of histology. Area under receiver operating characteristics curves was used for assessment of single markers and odds ratio for their combinations. RESULTS: Patients with advanced disease were older, had lower albumin, higher gamma glutamyl transferase and lower platelet. Levels of 6 of the 9 fibrosis markers, tissue inhibitor of metalloproteinases-1, procollagen type III aminoterminal propeptide, matrix metalloproteinase-2, laminin, hyaluronan and collagen IV correlated with advanced fibrosis. Markers useful for fibrosis prediction also predicted marked inflammation. Using the gold standard, age, prothrombin time, gamma glutamyl transferase and albumin were independent predictors of fibrosis with odds ratio's of 3.11, 4.18, 3.35 and 5.25, respectively. Their combined use predicted fibrosis with an odds ratio of 228.8. Tissue inhibitor of metalloproteinases-1 and hyaluronan were powerful predictors of fibrosis (Odds ratio's of 8.65 and 8.38). Their combined use revealed an odds ratio of 28.6, when compared with the gold standard. CONCLUSION: In conclusion, advanced liver fibrosis in chronic hepatitis B and D may be predicted with use of these two fibrosis markers.

What did we learn from the first 3,459 cases of liver stiffness measurement by transient elastography (FibroScan®)?

PURPOSE: Chronic viral hepatopathies can be evaluated through invasive or noninvasive methods. The aim of this paper was to assess the indications and results of transient elastographic (TE) evaluation of the liver in patients with chronic viral hepatitis and cirrhosis. MATERIALS AND METHODS: We retrospectively assessed all the liver stiffness measurements (LSM) (FibroScan®) performed over a two-year period (2007 - 2009). RESULTS: 3,459 TE evaluations were made mainly for the assessment of: HCV hepatitis, HBV infection (chronic hepatitis and inactive HBV carriers), biviral hepatitis (B + C or B + D), cirrhosis and in 176 normal subjects (to establish the normal values of LSM). From the 3,459 FS evaluations, we could not obtain valid LSM in 183 cases (5.3 %). 93.9 % of the patients in the failure group were overweight (BMI > 25 kg/m²). In 527 cases (16 %) the SR (success rate = number of valid measurements/total number of measurements) was < 60 %. TE reproducibility was analyzed in 287 cases. The ICCs for the three operators were 0.985, 0.949, and 0.874 respectively, and the overall ICC was 0.982. 596 cases of cirrhosis were evaluated. A cut-off value of 23.3kPa was found to predict the presence of at least grade 2 esophageal varices. CONCLUSION: LSM by means of TE is a promising noninvasive evaluation method, which can be used in numerous clinical situations, some in which its value is well established (suspicion of LC, predicting significant fibrosis) and some in which its value is less known (HBV chronic hepatitis, inactive HBV carriers or severity of portal hypertension).

Sonography of diffuse liver disease.

Sonography is often the first imaging procedure performed in the evaluation of individuals with suspected liver disease. Evaluation for biliary dilatation is always performed, because bile duct obstruction can cause abnormal liver test results, raising the suspicion of liver disease. Ultrasound is a useful but imperfect tool in evaluating diffuse liver disease. We discuss the uses and limitations of sonography in evaluating parenchymal liver disease. Sonography can show hepatomegaly, fatty infiltration of the liver, and cirrhosis, all with good but imperfect sensitivity and specificity. Sonography is of limited usefulness in acute hepatitis. Increased parenchymal echogenicity is a reliable criterion for diagnosing fatty liver. Cirrhosis can be diagnosed in the correct clinical setting when the following are present: a nodular liver surface, decreased right lobe-caudate lobe ratio, and indirect evidence of portal hypertension (collateral vessels and splenomegaly). Ultrasound plays an important role in the imaging of conditions and procedures common in patients with diffuse liver disease.