v. petrenkiene * , d. petrauskas l. kupcinskas, lithuanian university of health sciences
DESCRIPTION
Utility of non-invasive markers for prediction of significant hepatic fibrosis in chronic hepatitis C patients. V. Petrenkiene * , D. Petrauskas L. Kupcinskas, Lithuanian University of Health sciences Clinic of Gastroenterology Kaunas. BACKGROUND. - PowerPoint PPT PresentationTRANSCRIPT
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V. Petrenkiene*, D. Petrauskas L. Kupcinskas, Lithuanian University of Health sciences
Clinic of Gastroenterology Kaunas
Utility of non-invasive markers for prediction of significant hepatic
fibrosis in chronic hepatitis C patients
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• Over the past decade many studies have evaluated non-invasive tests of liver fibrosis to assess the presence and severity of fibrosis in chronic liver diseases.
• Non-invasive markers and commercial tests of liver fibrosis have been proposed and assessed in the clinical setting as surrogates of liver biopsy.
• However, their implementation in clinical practice is slow and still limited.
BACKGROUNDBACKGROUND
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AIM
To determine the utility of non-invasive markers using routine laboratory tests for the prediction of significant fibrosis and cirrhosis in a cohort of chronic hepatitis C (CHC) patients
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METHODS (1)
• Treatment naive 18-70 years old CHC patients with serum HCV-antibody and HCV RNA positivity.
• Having liver biopsy between Jan 2000 and Nov 2005 with sufficient liver tissue for fibrosis staging (>7 intact portal tracts).
• Having a blood sample drawn for the measurement of the liver panel and blood counts one day before the biopsy and abdominal ultrasound examinations with measurement of spleen diameter.
• Patients without a history of alcohol intake (> 30 g/day for males and 20 g/day for females).
• No evidence of other liver diseases.
Inclusion criteria
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Biopsy: Menghini 14-gauge needle;Histology: Knodell–Ishak fibrosis staging system on a scale F0-F6 (Masson trichrome stain).
1. Fibrosis of some portal areas. 3. Fibrosis with occasional (P-P) bridging.
4. Fibrosis with P-P and P-C bridging.5. Incomplete cirrhosis. 6. Cirrhosis, probable or definite.
2. Fibrosis expansion of most portal areas.
Staging was performed blinded to clinical data by one expert pathologist.
METHODS (2)METHODS (2)
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METHODS (3)
1. AAR - AST/ALT.
2. Platelet count.
3. APRI - AST/platelet count (×109/l)×100.
4. GUCI (the Göteborg University Cirrhosis Index):AST×prothrombin(INR)×100/platelet count (×109/l).
5. Platelet count/spleen diameter ratio index.
Indirect non-invasive testsof liver fibrosis used
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METHODS (4)
402 CHC PATIENTS REGISTERED FROM January 2000 UNTIL November 2005
323 CHC PATIENTSINCLUDED
43 patients with insufficient liver sample
31 patients with incomplete data
5 patients withactive alcohol abuse
F 0-2N=148
F 3-6N=175
F 5-6N=67
Flow diagram of the potential candidatesfor participation in the study
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RESULTS (1)
323 naive CHC patients 194 (60.1%) male 129 (39.9%) female
Mean age: 48.5 year Histological staging
F0 6.5% (n= 21) F1 13.9% (n= 45) F2 25.4% (n= 82) F3 23.5% (n= 76) F4 9.9% (n= 32) F5 3.7% (n= 12) F6 17.0% (n= 55)
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METHODS (5)
• Quantitative data were expressed as mean and standard error (SE).
• The variation in the proportions were assessed using Chi-square test. • P values of 0.05 were considered significant.
• The diagnostic value for each marker was assessed using the area under the receiver operating characteristics curves (AUROC).
• Statistical analysis was carried out using the SPSS 12.0 software
package.
Statistical analysis
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Results (2)
VariablesPrediction of significant fibrosis
(F3-F6)AUC (95%CI)
Prediction of cirrhosis(F5-F6)
AUC (95%CI)
Platelet count 0.69 (0.49-0.71) 0.85 (0.72-0.89)
AAR 0.65 (0.59-0.72) 0.76 (0.69-0.83)
APRI 0.73 (0.68-0.79) 0.89 (0.84-0.94)
GUCI 0.74 (0.69-0.79) 0.89 (0.85-0.95)
Platelet/spleendiameter
0.71 (0.65-0.77) 0.88 (0.88-0.93)
Variables for predictingsignificant fibrosis and cirrhosis
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RESULTS (3)
VariablesSignificant fibrosis
(F3-F6) Cirrhosis(F5-F6)
Presence Absence
APRI ≥1.5 <2.0
Platelet/spleen diameter <1.5 >1.5
AAR ≥ 1 <1
GUCI >1.5 <2.0
Platelet count <150 x10(9)/L ≥ 150 x10(9)/L
Cut-off points to predict the absence or presence of significant fibrosis and cirrhosis
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RESULTS (4)
Variables Sensitivity %
Specificity %
PPV % NPV % Accuracy %
Platelet count 42.5 87.8 80.4 56.5 63.4
AAR 46.8 89.2 83.7 58.7 66.3
APRI 81,4 61.7 79.5 70.7 72.1
GUCI 58.0 81.5 58.0 38.0 68.8
Platelet/spleen diameter
56.1 79.5 76.4 60.4 60.2
Sensitivity, specificity, positive (PPV), and negative (NPV) predictive value of evaluated parameters in detecting significant (F 3-6) fibrosis
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RESULTS (5)
Variables Sensitivity %
Specificity %
PPV % NPV % Accuracy %
Platelet count 73.1 83.1 52.3 92.2 81.1
AAR 80.1 81.6 50.0 92.9 80.5
APRI 83.6 85.5 60.2 95.2 85.1
GUCI 83.6 82.6 56.0 95.0 82.8
Platelet/spleen diameter
87.8 72.7 45.7 95.8 75.9
Sensitivity, specificity, positive (PPV), and negative (NPV) predictive value of evaluated parameters in detecting cirrhosis (F 5-6)
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CONCLUSIONS (1)
• Non-invasive tests of liver fibrosis based on a few standard laboratory tests: APRI, platelet count, AST/ALT ratio, GUCI, platelet count/spleen diameter ratio are useful to predict advanced fibrosis in HCV-infected patients and can bee used in clinical setting when liver biopsy is not available (outpatient care, regional hospitals).
• Prediction of cirrhosis (F5-F6) by simple non-invasive tests is superior to prediction of significant fibrosis (F3-F6).
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CONCLUSIONS (2)
• Implementation of fibrosis markers using routine laboratory tests can reduce, but not completely eliminate, the need for liver biopsy.
• Therefore,, liver biopsy still remain a ‘gold standard’ foriver biopsy still remain a ‘gold standard’ for assessment assessment ofof liver liver fibrosis in tertiary hospital setting.fibrosis in tertiary hospital setting.
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Kaunas, Lithuania