AIM: Acoustic radiation force impulse (ARFI) technology, involving the shear wave velocity (SWV) with virtual touch tissue quantification (VTTQ), are currently available for the assessment of liver fibrosis, while there is no index derived from the combination of SWV and blood tests. The aim of this study was to develop a new index for assessment of liver fibrosis.
METHODS: The subjects were 176 consecutive patients with hepatitis C (training set [n = 120] and validation set [n = 56]) who underwent liver biopsy in our institution.
RESULTS: In the training set, SWV, international normalized ratio (INR) and alanine aminotransferase (ALT) correlated independently and significantly with fibrosis. According to this, we developed the VIA index = -1.282 + 0.965 × SWV + 1.785 INR + 0.00185 ALT. The areas under the receiver-operator curve (AUROC) of the VIA index were 0.838 for the diagnosis of significant fibrosis (≥F2), 0.904 for the severe fibrosis (≥F3) and 0.958 for the cirrhosis (F4) in the training set. While in the validation set, AUROC of the VIA index were 0.917 for F2 or higher, 0.906 for F3 or higher and 1.000 for F4, respectively. AUROC of the VIA index was improved compared to SWV alone, equivalent for VIA for the diagnosis of F2 or higher, and superior to that of FIB-4 index and aspartate aminotransferase-to-platelet ratio index for the diagnosis of F3 or higher and F4.
CONCLUSION: The VIA index is potentially more useful for assessment of liver fibrosis than SWV alone, and easily and accurately measures liver fibrosis stage.
Evaluación de la fibrosis hepática es crítico para el éxito de la gestión de la enfermedad individualizada en personas con hepatitis B crónica (CHB) o la hepatitis crónica C (HCC). Hemos ampliado y validado índices de marcador sérico para proporcionar métodos precisos, reproducibles y de fácil aplicación de la evaluación de la fibrosis. resultados de la biopsia hepática de más de 284 CHB y 2304 pacientes con HCC en la hepatitis crónica Cohort Study ( 'CHeCS') fueron asignadas a una escala equivalente F0-F4. APRI y FIB-4 puntajes dentro de una ventana de 6 meses de la biopsia fueron asignadas a la misma escala. Un nuevo algoritmo se aplicó para obtener y validar los límites óptimos para diferenciar los niveles de fibrosis. Para la predicción de fibrosis avanzada y cirrosis, la puntuación FIB-4 superó a los otros índices de marcador sérico de la cohorte CHC y fue similar a APRI en la cohorte CHB. El área bajo la curvas características de funcionamiento (AUROC) para el FIB-4 en la diferenciación de F3-F4 de F0-F2 (IC del 95%: 0,80 a 0,92) 0,86 para CHB y 0,83 (IC del 95%: 0,81 hasta 0,85) para el CHC . Los puntos de corte sugeridos basados en el FIB-4 modelo producido altos valores predictivos positivos [CHB: 90,0% para F0-F2, 100,0% para la cirrosis (F4); CHC: 89,7% para F0-F2; 82,9% para la cirrosis (F4)]. En este gran cohorte observacional, FIB-4 predijo el extremo superior e inferior del estadio de fibrosis hepática (cirrosis y F0-F2, respectivamente), con un alto grado de exactitud, tanto en CHB y los pacientes con HCC.
AIM: en tiempo real la elastografía de tejidos (RTE) es un método no invasivo para medir la elasticidad de los tejidos mediante ecografía. La fibrosis hepática (LF) índice es un método cuantitativo para la evaluación de la fibrosis hepática calculado por características de la imagen RTE. Este estudio tuvo como objetivo investigar la importancia del índice LF para la predicción de la fibrosis hepática en pacientes con hepatitis C crónica.
MÉTODOS: En este estudio prospectivo, se incluyeron 115 pacientes con hepatitis C crónica que se sometieron a una biopsia hepática, y se evaluó la precisión diagnóstica del índice LF y los marcadores séricos de fibrosis.
RESULTADOS: imágenes RTE se realizó con éxito en todos los pacientes. Índice LF mediana en pacientes con F0-1, F2, F3 y F4 fueron 2,61, 3,07, 3,54 y 4,25, respectivamente, lo que demuestra un aumento gradual con la progresión de la fibrosis hepática (p <0,001). LF índice (odds ratio [OR] = 5,3, 95% intervalo de confianza [IC] = 2,2-13,0) y el recuento de plaquetas (OR = 0,78; IC del 95% = 0,68 hasta 0,89) se asociaron de forma independiente con la presencia de fibrosis avanzada (F3 -4). Además, el índice de LF se asoció de forma independiente con la presencia de fibrosis mínima (F0-1) (OR = 0,25; IC del 95% = 0,11-0,55). El área bajo la curva receptor-operador (AUROC) de índice de LF para la predicción de fibrosis avanzada (0,84) fue superior a las plaquetas (0,82), FIB-4 índice (0,80) y aspartato aminotransferasa / índice de plaquetas ratio (APRI) (0.76). AUROC del índice LF (0,81) fue superior a las plaquetas (0,73), FIB-4 índice (0,79) y el APRI (0.78) en la predicción de la fibrosis mínima.
CONCLUSIÓN: índice LF calculada por RTE es útil para predecir la fibrosis hepática y la precisión diagnóstica del índice LF es superior al suero marcadores de fibrosis.
The degree of liver fibrosis is strongly associated with the antiviral effect of interferon on chronic hepatitis C patients. In this study, the accuracy of acoustic radiation force impulse (ARFI) in assessing liver fibrosis and the association between liver stiffness using ARFI and antiviral effects were investigated. The 124 patients with chronic hepatitis C enrolled in this study included 94 with HCV genotype 1 and 40 (30%) with moderate fibrosis (METAVIR fibrosis score ≥ F2). Sixty-one patients received pegylated interferon (peg-IFN) plus ribavirin combination therapy and the treatment responses were assessed. The shear wave velocity (Vs value) by ARFI had a strong correlation with the histological fibrosis stage (P < 0.001). The AUROC of the Vs value, aspartate aminotransferase platelet ratio index and FIB4 for the diagnoses of moderate fibrosis (≥F2) were 0.890, 0.779, and 0.737, respectively. HCV genotype 1 patients with the TT allele of IL28B and with a low Vs value (<1.40 m/sec) who were treated with peg-IFN plus ribavirin therapy achieved a sustained virologic response at a rate of 79% (15/19), while all patients with the TG/GG allele of IL28B and a high Vs value (≥1.40 m/sec) experienced a non-virologic response (6/6). The Vs value measured by ARFI could not predict the treatment response for patients with HCV genotype 2. It is concluded that the combination of ARFI at cut off of 1.4 m/sec and IL28B may be useful for patients with chronic hepatitis C with genotype 1 treated with peg-IFN/ribavirin combination therapy.
BACKGROUND: Staging of liver fibrosis in patients with chronic hepatitis C (CHC) is recommended prior to anti-viral therapy. As vWF-Ag was shown as a predictor of portal hypertension, decompensation and mortality in patients with liver cirrhosis, we performed this study to investigate if vWF-Ag is able to predict different fibrosis stages and if it is comparable to other fibrosis scores.
AIM: To investigate if vWF-Ag is able to predict different fibrosis stages and if it is comparable to other fibrosis scores.
METHODS: We analysed 294 patients with chronic hepatitis C who underwent biopsy. We assessed stage of liver fibrosis according to Metavir, measured vWF-Ag and calculated different fibrosis scores (APRI, FCI, FORNS, FI, Fib-4) and compared them by AUCs. We also calculated a new score: vWF-Ag/thrombocytes (VITRO score) for prediction of fibrosis.
RESULTS: vWF-Ag levels were increasing with stage of fibrosis: F0: vWF-Ag was median 136.5%, FI 140.6%, FII 157.5%, FIII 171.0%, FIV 252.0%; P < 0.001. vWF-Ag and VITRO score produced AUCs of 0.7 and 0.72 for ≥F2, comparable to the AUCs of APRI, Fib-4, FORNS with 0.75, 0.65 and 0.64 (P > 0.05). For ≥F3 AUCs were 0.79 and 0.86 for vWF-Ag and VITRO score, comparable with AUCs of 0.79, 0.86 and 0.87 for APRI, Fib-4 and FORNS. Cirrhosis shows AUCs of 0.84 and 0.89 for vWF-Ag and VITRO score, APRI, Fib-4 and FORNS showed similar results with AUCs of 0.82, 0.88 and 0.87.
CONCLUSIONS: vWF-Ag and VITRO score offer an easy possibility to evaluate the stage of fibrosis to diagnose subclinical cirrhosis in patients with chronic hepatitis C. Both vWF-Ag and VITRO score show equal performance in comparison to other fibrosis scores assessed in our study.
AIM: To provide a simple fibrosis index combining the routine laboratory markers for predicting significant fibrosis (SF) and cirrhosis in patients with chronic HCV.
METHODS: Platelet count, ALT, AST, AST to ALT Ratio, AST to Platelet Ratio Index (APRI), Forns index, FIB-4 and Age Platelet Index of 202 liver biopsy performed HCV-infected patients were reviewed. METAVIR classification was used to determine the stage of liver fibrosis. The predictive fibrosis index was constructed by multiple linear regression analysis (- 2.948 + 0.562 × Forns index + 0.288 × APRI + 0.006 × platelet count [10(9)/L]).
RESULTS: Median (25th-75th interquartile range) age was 52 (42-59) years, and 61% were male. 65.8% (n = 133) had SF (F2-F4) and 23.3% (n = 47) had cirrhosis (F4). For discrimination of SF, AUROCs were: Fibrosis index = 0.869, Forns index = 0.837, APRI = 0.814, platelet count = 0.764. For cirrhosis, AUROCs were: Fibrosis index = 0.911, Forns index = 0.883, APRI = 0.847, platelet count = 0.827. A cut-off point of ≤ 1.2 for fibrosis index excluded SF in 89% of patients with sensitivity of 96%, while > 2.0 predicted SF in 88% of patients with specificity of 86%. Threshold of ≤ 1.9 excluded cirrhosis in 95% of patients with sensitivity of 94%, while > 2.7 showed cirrhosis in 88% of patients with specificity of 95%. In multivariate logistic regression analysis, OR (95% CI) of fibrosis index was 7.825 (3.682-16.629) for SF (p < 0.001) and was 8.672 (4.179-17.996) for cirrhosis (p < 0.001).
CONCLUSION: SF and cirrhosis were predicted with accuracy of 82% and 89% and were excluded with accuracy of 74% and 82% using this fibrosis index which may potentially decrease the need for liver biopsy in 76% and 83% of patients, respectively.
ANTECEDENTES Y OBJETIVOS: la elastografía transitoria (TE) es una herramienta no invasiva validado para evaluar la fibrosis hepática en pacientes con infección por el virus de la hepatitis C (VHC). Ya sea TE puede detectar cambios de la fibrosis hepática siguientes erradicación del VHC terapéutico nunca ha sido evaluado.
MÉTODOS: 37 cirróticos por VHC con pares de respuesta virológica (RVS) biopsias hepáticas antes y después de sostenido (LB) fueron sometidos a TE en el momento de la post-SVR LB. La fibrosis hepática fue puesta en escena con el sistema de puntuación METAVIR y el área de fibrosis (%) se evaluó morfométricamente.
RESULTADOS: Treinta y tres pacientes tuvieron mediciones TE válidos después de 61 (48-104) meses a partir de la RVS, y 20 (61%) de ellos tenían regresión cirrosis. El post-SVR LB, la zona media de la fibrosis fue de 2,3%, reduciéndose significativamente desde la línea base (p <0,0001). Valor del medio TE fue de 9,8 kPa siendo menor en pacientes regresivos vs. no regresión (9,1 kPa vs. 12,9 kPa, p = 0,01). TE fue <12 kPa en 5 pacientes (38%) F4 y en 19 (95%) ≤F3 pacientes (p = 0,0007). La precisión diagnóstica de TE para diagnosticar F4 después del tratamiento fue del 61% de sensibilidad, especificidad del 95%, 12,3 + LR, LR-0.4, y AUROC 0,77. Se observó una correlación significativa entre TE y tanto el estadio de fibrosis (r = 0,56; p = 0,001) y la morfometría (r = 0,56, p = 0,001), así como entre el estadio de fibrosis y el área de fibrosis (r = 0,72, p = 0,001) .
CONCLUSIONES: Después de la erradicación de la terapéutica del VHC, el poder predictivo de la corte de viremia de 12 kPa fue baja como consecuencia de la remodelación del hígado y la reabsorción de la fibrosis. LB sigue siendo el único método fiable para la fibrosis hepática etapa siguiente una RVS.
AIM: To compare results of liver stiffness measurements by transient elastography (TE) obtained in our patients population with that used in a recently published meta-analysis.
METHODS: This was a single center cross-sectional study. Consecutive patients with chronic viral hepatitis scheduled for liver biopsy at the outpatient ward of our Infectious Diseases Department were enrolled. TE was carried out by using FibroScan™ (Echosens, Paris, France). Liver biopsy was performed on the same day as TE, as day case procedure. Fibrosis was staged according to the Metavir scoring system. The diagnostic performance of TE was assessed by using receiver operating characteristic (ROC) curves and the area under the ROC curve analysis.
RESULTS: Two hundred and fifty-two patients met the inclusion criteria. Six (2%) patients were excluded due to unreliable TE measurements. Thus, 246 (171 men and 75 women) patients were analyzed. One hundred and ninety-five (79.3%) patients had chronic hepatitis C, 41 (16.7%) had chronic hepatitis B, and 10 (4.0%) were coinfected with human immunodeficiency virus. ROC curve analysis identified optimal cut-off value of TE as high as 6.9 kPa for F ≥ 2; 7.9 kPa for F ≥ 3; 9.6 kPa for F = 4 in all patients (n = 246), and as high as 6.9 kPa for F ≥ 2; 7.3 kPa for F ≥ 3; 9.3 kPa for F = 4 in patients with hepatitis C (n = 195). Cut-off values of TE obtained by maximizing only the specificity were as high as 6.9 kPa for F ≥ 2; 9.6 kPa for F ≥ 3; 12.2 kPa for F = 4 in all patients (n = 246), and as high as 7.0 kPa for F ≥ 2; 9.3 kPa for F ≥ 3; 12.3 kPa for F = 4 in patients with hepatitis C (n = 195).
CONCLUSION: The cut-off values of TE obtained in this single center study are comparable to that obtained in a recently published meta-analysis that included up to 40 studies.
OBJETIVOS: El objetivo de este estudio fue evaluar el uso potencial de suero factor de crecimiento transformante β1 (TGF-β1), inhibidor tisular de la metaloproteinasa-1 (TIMP-1), fetuina-A, y el factor de crecimiento de fibroblastos 21 (FGF21) en la detección de la fibrosis hepática en pacientes con hepatitis B crónica (CHB). También se examinó - El valor de los modelos de fibrosis no invasivos - es decir, la aspartato aminotransferasa índice de la relación de plaquetas (APRI), el índice de fibrosis basado en los cuatro factores (FIB-4), y el índice de puntuación de Forn.
Material y métodos: pacientes que se sometieron a CHB biopsia hepática para la evaluación de la fibrosis fueron incluidos en el estudio. Un total de 73 pacientes fueron divididos en dos grupos en función de su puntuación METAVIR (F0-1, no / fibrosis mínima; F2-4, fibrosis significativa). Se midieron los niveles séricos de TGF-β1, TIMP-1, fetuina-A, y FGF21 además APRI, FIB-4, y las puntuaciones del Forn. El área bajo la curva ROC fue medida para cada parámetro, seguido por el cálculo de la sensibilidad, especificidad y valores predictivos positivos y negativos.
RESULTADOS: APRI, FIB-4, y las puntuaciones del índice de Forn fueron significativamente mayores en los pacientes con fibrosis significativa (P <0,05). No hubo diferencia entre no / mínima fibrosis y grupos fibrosis significativa en términos de los niveles séricos de TGF-1, TIMP-1, fetuina-A, y FGF21 (P> 0,05). Las áreas bajo la curva ROC para el TGF-β1, TIMP-1, fetuina-A, FGF21, APRI, FIB-4, y el índice de Forn fueron 0.445, 0.483, 0.436, 0.585, 0.662, 0.687 y 0.680, respectivamente.
CONCLUSIÓN: Nuestros resultados sugieren que el suero de TGF-β1, TIMP-1, fetuina-A, y FGF21 no son útiles para la evaluación de la extensión de la fibrosis hepática en CHB en este grupo de pacientes. Sin embargo, APRI, FIB-4, y el Forn del índice tiene un mejor valor diagnóstico en pacientes con fibrosis significativa que en aquellos con no / mínima fibrosis.
PURPOSE: To compare the diagnostic performance of acoustic radiation force impulse (ARFI) elastography with that of FibroScan M and XL probes and FibroTest in the staging of fibrosis in patients with chronic liver disease.
MATERIALS AND METHODS: This study received ethics approval, and all participants provided written informed consent. A total of 321 consecutive patients with chronic liver disease who underwent liver biopsy were prospectively enrolled from April 2010 to May 2012. Liver disease was caused by viral hepatitis (n = 136), alcoholic or nonalcoholic steatohepatitis disorders (n = 113), or some other disease (n = 72). In each patient, liver stiffness was evaluated with ARFI elastography, M and XL probes, and FibroTest within 1 month before liver biopsy. Histologic staging of liver fibrosis served as the reference standard.
RESULTS: Liver stiffness measurement failure rates were 11.2% with the M probe (36 of 321 patients), 2.3% with the XL probe (six of 260 patients), and 0% with ARFI elastography (0 of 321 patients). Unreliable results with ARFI elastography were more frequent in obese patients (those with a body mass index of 30 kg/m(2) or more) (42 of 86 patients [48.8%] vs 34 of 235 patients [14.5%], P < .0001). No significant difference was found between ARFI elastography and the M probe in the diagnosis of cirrhosis (area under under the receiver operating characteristic curve [Az], 0.88 vs 0.91; P = .12) or severe fibrosis (Az, 0.85 vs 0.89; P = .15); however, the M probe demonstrated better results in the diagnosis of moderate fibrosis (Az, 0.81 vs 0.88; P = .008). No significant difference was found between ARFI elastography and the XL probe in the diagnosis of moderate fibrosis, severe fibrosis, or cirrhosis. The diagnostic performance of ARFI elastography improved when it was applied in nonobese patients (Az of ARFI for cirrhosis and severe fibrosis = 0.92 and 0.91, respectively, in nonobese patients [P = .0002] and 0.63 and 0.63, respectively, in obese patients [P < .0001]).
CONCLUSION: ARFI elastography is reliable in the assessment of liver fibrosis in patients with chronic liver disease, especially nonobese patients.
Acoustic radiation force impulse (ARFI) technology, involving the shear wave velocity (SWV) with virtual touch tissue quantification (VTTQ), are currently available for the assessment of liver fibrosis, while there is no index derived from the combination of SWV and blood tests. The aim of this study was to develop a new index for assessment of liver fibrosis.
METHODS:
The subjects were 176 consecutive patients with hepatitis C (training set [n = 120] and validation set [n = 56]) who underwent liver biopsy in our institution.
RESULTS:
In the training set, SWV, international normalized ratio (INR) and alanine aminotransferase (ALT) correlated independently and significantly with fibrosis. According to this, we developed the VIA index = -1.282 + 0.965 × SWV + 1.785 INR + 0.00185 ALT. The areas under the receiver-operator curve (AUROC) of the VIA index were 0.838 for the diagnosis of significant fibrosis (≥F2), 0.904 for the severe fibrosis (≥F3) and 0.958 for the cirrhosis (F4) in the training set. While in the validation set, AUROC of the VIA index were 0.917 for F2 or higher, 0.906 for F3 or higher and 1.000 for F4, respectively. AUROC of the VIA index was improved compared to SWV alone, equivalent for VIA for the diagnosis of F2 or higher, and superior to that of FIB-4 index and aspartate aminotransferase-to-platelet ratio index for the diagnosis of F3 or higher and F4.
CONCLUSION:
The VIA index is potentially more useful for assessment of liver fibrosis than SWV alone, and easily and accurately measures liver fibrosis stage.
