Non-invasive serum markers and transient elastography in staging advanced chronic hepatitis C
Keywords: non-invasive serum markers, liver fibrosis, liver cirrhosis, transient elastography, hepatitis C
AbstractObjectives. In the past decade researchers are presenting indirect non-invasive serum markers for liver fibrosis and cirrhosis evaluation. Our aim was to evaluate effectiveness in staging advanced liver disease when using transient elastography and nine non-invasive serum markers: APRI, FIB-4, ASPRI, LSPS, P2/MS, FibroQ, Fibro-α, Pohl, CDR. Methods. 162 patients with hepatitis C infection were included in this study. Patients were divided in two groups, regarding histopathologic results: advanced liver fibrosis and cirrhosis. The following laboratory measures were obtained in all patients: ALT, AST, albumin, total bilirubin, alkaline phosphatase, gamma glutamyl transferase, INR, hemoglobin, platelet count, alfa fetoprotein, segmented neutrophils count and percentage and monocytes percentage. Transient elastography and nine non-invasive serum markers – APRI, FIB-4, ASPRI, LSPS, P2/MS, FibroQ, Fibro-α, Pohl, CDR – were compared with the results of the histopathological examination. A statistical analysis was done using the Student t-test, the Spearman’s rank correlation and the area under receiver-operating characteristic curves (AUROCs). Results. All nine non-invasive markers correlated significantly with the liver fibrosis stage (P < 0.001). Patients with liver cirrhosis had significantly higher ASPRI, LSPS, FIB-4, FibroQ, APRI, Fibro-α, Pohl and transient elastography scores in comparison with significant fibrosis (P < 0.05). The Pohl score indicated cirrhosis in 45.6% of cirrhotic patients, whereas it was positive in only 5.7% of non-cirrhotic patients (P < 0.05). P2/MS and CDR markers showed no significant difference between fibrosis and cirrhosis groups. The LSPS non-invasive marker showed the highest diagnostic efficiency for liver cirrhosis diagnosis, when using the cutoff score ≥0.99 (sensitivity 86.96%, specificity 85.71%, positive predictive value 88.9%, negative predictive value 83.3%). Transient elastography also showed high efficiency for liver cirrhosis diagnosis: using a cutoff value of ≥12 (kPa), sensitivity, specificity, positive and negative predictive values were 84.78, 80.00, 84.8 and 80.0%, respectively. Conclusions. In our study the most efficient for liver cirrhosis diagnosis were the LSPS non-invasive serum marker and transient elastography.