Transient Elastography Compared to FIB 4 to Evaluate Patients with Chronic Hepatitis C

Abstract

HCV is one of the major causes of chronic liver diseases, which include inflammation, fibrosis and cirrhosis. Furthermore, HCV has been associated with increased morbidity and mortality in hepatocellular carcinoma (Shaheen et al., 2007; Sebastiani, 2009; Lin, et al., 2001). Histological assessment of liver fibrosis is a crucial part of the evaluation of patients infected with hepatitis C virus (HCV) (Bonnard et al., 2015). Liver biopsy (LB) remains the gold standard to assess liver fibrosis in chronic hepatitis C (CHC) and is required to decide whether a treatment should be proposed. Many of its disadvantages have led to develop noninvasive methods to replace LB. These new methods should be evaluated in Egypt, where circulating virus genotype 4 (G4) (Elsharkawy et al., 2015). Liver fibrosis was reportedly predicted by measurement of liver stiffness using transient elastography (Friedrich-Rust et al., 2008). As assessed by blood laboratory tests, the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, AST/platelet ratio index (APRI), and FIB-4 index have been reported to be useful for the prediction of liver fibrosis (Sterling et al., 2006;Vallet-Pichard et al., 2007). This study aimed to assess the efficacy of transient elastography and FIB-4 in diagnosis of liver fibrosis in comparison with liver biopsy to avoid the obstacle by the fact that sampling errors and interpreter biases may reduce diagnostic accuracy of liver biopsy, and invasive procedure with certain unavoidable risks and complications is not practical to follow-up disease progression and treatment response. Therefore, the growing need for alternative approaches to the assessment of liver disease severity has driven the development of several non-invasive methods in order to overcome the limitations of liver biopsy. Transient elastography and FIB-4 index were compared to liver biopsy showing higher correlation of transient elastography more than FIB-4 index. There is still no perfect surrogate or method able to completely replace liver biopsy. Therefore, information deriving from both noninvasive methods and liver biopsy should be integrated in a complementary approach for long-term management of chronic liver disease. Algorithms combining the most validated noninvasive methods could also be used as initial screening tools, avoiding liver biopsy, especially if cirrhosis or minimal to no fibrosis, is predicted by these tests. In cases of indeterminate results liver biopsy can be performed to confirm the exact stage of fibrosis.