FIB-4 and platelet indices as non invasive predictors of liver fibrosis in Egyptian patients with chronic hepatitis C virus infection

Abstract

Liver is the main storage for different nourishment of the body and also the main detoxifier of the different ingested toxins and drugs and even some hormones, indespite of the fact that it is the largest gland in the body. Liver biopsy is a well known invasive technique to assess the effect - and even diagnose – of different diseases on the liver parenchyma specially the endemic HCV in Egypt. An extensive interest in developing non-invasive tests that can be used reliably in clinical practice with benefits in terms of cost, risk and patient convenience is growingly present. Clinically applicable non-invasive tests include radiological studies, transient elastography and serum markers. The aim of this study is to evaluate whether Fib 4 and other platelet indices would be useful in predicting degree of liver fibrosis in chronic hepatitis C infected patients. In our study we had a 100 patients at Ain-Shams university hospitals and police authority hospitals that were applicants to the pegylated interferon based anti-HCV regimen which required a liver biopsy being assessed for each patient. We conducted a prospective study on the collected data regarding the non-invasive tests of (MPV, PDW, FIB-4 index and APRI formula) and there sensitivity, specificity, statistical difference and correlation between the different stages of fibrosis and the each of the studied serum marker. We had 12 patients with no fibrosis (F0) (12%), 48 patients with mild fibrosis (F1) (48%), 20 patients with significant fibrosis (F2) (20%), 12 patients had advanced fibrosis (F3) (12%) and 8 patients had established cirrhosis (F4) (8%). The study showed the following: • The older the age of the patients, the more the degree of the hepatic fibrosis. • Obesity with higher BMI is associated with higher degree of hepatic fibrosis. • Serum AST level is a good predictive variable for histological activity and hepatic fibrosis. • Serum AFP level is correlated with advanced fibrosis/cirrhosis. • Patients with significant fibrosis/cirrhosis had significantly lower platelets count with increase of MPV and PDW. • The lower serum albumin level and higher INR, the higher the fibrosis score was. • ALT level show no significant correlation to the fibrosis score.

A significant positive correlation between the fibrosis stage and studied non-invasive indices was found. Also, a significant statistical difference between all fibrosis stages regarding the values of all studied non-invasive indices was found. So in conclusion we found FIB-4 formula and APRI index are good and reliable non invasive indices of the liver parenchyma affection by CHCV. Also MPV and PDW showed significant findings that would need further analytic studies.