Liver Fibrosis Estimation by Noncommercial Serum Markers and Transient Elastography in HCV

Significant fibrosis and cirrhosis can be predicted with high accuracy using noncommercial serum markers or transient elastography (TE) in hepatitis C virus (HCV)-infected patients receiving direct-acting antiviral treatment, according to a prospective, multicenter, observational study published in the Journal of Viral Hepatitis.¹

Treatment decisions in patients with chronic HCV infection are often based on the extent of hepatic fibrosis incurred.^2-4 Although liver biopsy is the gold standard for staging fibrosis, it is invasive and there are limitations to its accuracy. Therefore, noninvasive diagnostic tools such as TE may help avoid liver biopsy.^5,6 Real-world data comparing different noninvasive assessments of liver fibrosis are lacking, so researchers evaluated the diagnostic accuracy of a panel of noncommercial serum scores and TE in 2458 patients in Germany with valid data on TE who started direct-acting antiviral-based therapy between February 1, 2014, and September 30, 2015.¹ The noncommercial serum aspartate aminotransferase-to-platelet ratio index, the FORNS index (which uses age, gamma-glutamyltransferase, cholesterol, and platelet count), and the FIB-4 score (which uses age, aspartate aminotransferase, alanine aminotransferase, and platelet count) were calculated, and their diagnostic accuracy was compared with TE.

The researchers found that as estimated by TE, 955 (38.9%) patients did not have significant fibrosis, 736 (29.9%) patients had significant fibrosis, and 767 (31.2%) patients had cirrhosis. Significant fibrosis and cirrhosis were predicted with a diagnostic accuracy between 78.9% and 83.8%, as well as 84.6% and 90.7% with the noncommercial markers, using TE as reference.

“In conclusion, in the present multicenter real-world cohort, [significant fibrosis] and cirrhosis were predicted with high accuracy with non-commercial serum markers using TE as reference,” stated the authors.¹ Long-term, prospective studies are needed to compare serum markers with TE concerning liver-related outcome and overall mortality.

References

1. Knop V, Hofmann WP, Buggisch P, et al. Estimation of liver fibrosis by non-commercial serum markers in comparison to transient elastography in patients with chronic hepatitis C virus infection receiving direct acting antiviral treatment [published online October 13, 2018]. J Viral Hepat. doi: 10.1111/jvh.13021
2. van der Meer AJ, Veldt BJ, Feld JJ, et al. Association between sustained virological response and all-cause mortality among patients with chronic hepatitis C and advanced hepatic fibrosis. JAMA. 2012;308:2584-2593.
3. Everson GT, Hoefs JC, Seeff LB, et al. Impact of disease severity on outcome of antiviral therapy for chronic hepatitis C: Lessons from the HALT-C trial. Hepatology. 2006;44:1675-1684.
4. Ferenci P, Kozbial K, Mandorfer M, Hofer H. HCV targeting of patients with cirrhosis. J Hepatol. 2015;63:1015-1022.
5. Friedrich-Rust M, Ong MF, Martens S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology. 2008;134:960-974.
6. Talwalker JA, Kurtz DM, Schoenleber SJ, West CP, Montori VM. Ultrasound-based transient elastography for the detection of hepatic fibrosis: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2007;5:1214-1220.