Transient Elastography Assessed Liver Stiffness for Estimating Chronic Hepatitis C Prognosis

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Liver stiffness progression rates as measured by TE are consistent with traditional fibrosis progression rates in predicting time to cirrhosis.
Liver stiffness progression rates as measured by TE are consistent with traditional fibrosis progression rates in predicting time to cirrhosis.

Transient elastography (TE) is a noninvasive alternative to establish the prognosis of chronic hepatitis C by measuring liver stiffness progression rates (LSPRs); however, further studies are needed to obtain more precise estimates of prognosis, according to a systematic review and meta-analysis published in the Journal of Viral Hepatitis.1

Although liver biopsy is considered to be the “gold standard” for assessing the level of fibrosis in patients with chronic hepatitis C, it is an invasive procedure with limited diagnostic accuracy.2-6

Researchers sought to estimate prognosis in treatment-naive patients with chronic hepatitis C using TE-based LSPRs, and compared the consistency between LSPRs and traditional fibrosis progression rates (FPRs).1 They identified 27 studies that reported on 5874 treatment-naive individuals infected with HCV; 35 groups of patients allowed for indirect estimation of liver stiffness measurement progression and 8 groups of patients allowed for direct estimation using a longitudinal evaluation of liver stiffness.

Approximately 58% of patients were coinfected with HIV, and progression appeared to be faster for those coinfected with HIV/HCV compared with those with HCV infection only.

The estimated time to cirrhosis based on TE was 39 years compared with 38 years using liver biopsy. Thus, the LSPR was consistent with FPRs in predicting time to cirrhosis; however, there was less consistency for early stage progression. 

In addition, male sex and HIV were positively associated with LSPRs, whereas age at assessment was negatively associated with LSPRs.

“Noninvasive prognosis of HCV is consistent with FPRs in predicting time to cirrhosis, but more longitudinal studies of liver stiffness are needed to obtain refined estimates,” concluded the authors.1

Disclosures

Please refer to original reference for full list of author disclosures.

References

  1. Erman A, Sathya A, Nam A, et al. Estimating chronic hepatitis C prognosis using transient elastography-based liver stiffness: a systematic review and meta-analysis. J Viral Hepat. 2018;25(5):502-513.
  2. Boony C, Rayssiguier R, Ughetto S, et al. Medical practices and expectations of general practitioners in relation to hepatitis C virus infection in the Auvergne region [in French]. Gastroenterol Clin Biol. 2003;27:1021-1025.
  3. Bedossa P, Dargère D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology. 2003;38:1449-1457.
  4. Regev A, Berho M, Jeffers LJ, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol. 2002;97:2614-2618.
  5. Sandrin L, Fourquet B, Hasquenoph J-M, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003;29:1705-1713.
  6. Afdhal NH, Nunes D. Evaluation of liver fibrosis: a concise review. Am J Gastroenterol. 2004;99:1160-1174.
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