Abstract

Objectives: To analyse the Role of Fibroscan (FS) and non-invasive markers to assess hepatic fibrosis and steatosis at initial presentation of patients with Hepatitis B.

Methods: An observational prospective study of patients with chronic hepatitis B (CHB) evaluated at single Liver Clinic, Mumbai from April 2014-March 2017. Serological markers, transient elastography (fibroscan) for HF, APRI, FIB-4, AST/ALT ratio and E-score were analyzed. Controlled attenuation parameter (CAP) score on fibroscan was used for grading of hepatic steatosis. Patients were categorized into 2 groups: No significant fibrosis (< F2), significant fibrosis (> F2) group. AST/ALT ratio was divided into 2 groups: No significant fibrosis for ≤ 1, significant fibrosis > 1.

Results: 178 study patients with male preponderance (68%), had asymptomatic infection, 24 patients were symptomatic; ascites (7), variceal bleeding (11) and hepatocellular carcinoma (8). 139 patients underwent fibroscan, 80 had HS on CAP score. 40/100 patients with normal AST and ALT had significant fibrosis (> F2) on fibroscan. Amongst noninvasive biochemical tools, only FIB-4 had significant correlation with fibroscan, (p < 0.05). The ROC curve areas (AUROC) of FIB-4, APRI and AST/ALT ratio that differentiated patients with significant HF from without fibrosis was 0.704, 0.674, 0.567, respectively. The sensitivity and specificity of FIB-4, APRI and AST/ALT ratio to differentiate patients with significant HF from those without was 42.6% and 92.3%, 72.1% and 60.2%, 29.5% and 83.3%, respectively.

Conclusion: Fibroscan and FIB-4 had significant correlation of HS in CHB patients. These can be used as non-invasive modalities to monitor HS in CHB patients.

Keywords: Hepatitis B; Hepatic Fibrosis; Hepatic Steatosis; Transient Elastography

References

1. Tandon BN., et al. “Epidemiology of Hepatitis B virus infection in India”. Gut 38 (1996): 56-59.
2. Ganem D and Prince AM. “Hepatitis B virus infection--natural history and clinical consequences”. The New England Journal of Medicine 350 (2004): 1118-1129.
3. Iloeje UH., et al. “Natural history of chronic hepatitis B: what exactly has REVEAL revealed?” Liver International 32 (2012): 1333-1341.
4. Jang JW., et al. “Long-term effect of antiviral therapy on disease course after decompensation in patients with hepatitis B virus-related cirrhosis”. Hepatology 61 (2015): 1809-1820.
5. Chon YE., et al. “Improvement of liver fibrosis after long-term antiviral therapy assessed by fibroscan in chronic hepatitis B patients with advanced fibrosis”. American Journal of Gastroenterology 112 (2017): 882-891.
6. Kim JH., et al. “Clinical application of transient elastography in patients with chronic viral hepatitis receiving antiviral treatment”. Liver International 35 (2015): 1103-1115.
7. Bondini S., et al. “Impact of non-alcoholic fatty liver disease on chronic hepatitis B”. Liver International 27 (2007): 607-611.
8. Minakari M., et al. “Liver steatosis in patients with chronic hepatitis B infection: host and viral risk factors”. European Journal of Gastroenterology and Hepatology 21 (2009): 512-516.
9. Cardoso AC., et al. “Diagnostic performance of controlled attenuation parameter for predicting steatosis grade in chronic hepatitis B”. Annuals of Hepatology6 (2015): 826-836.
10. Xu L., et al. “A comparison of hepatic steatosis index, controlled attenuation parameter and ultrasound as noninvasive diagnostic tools for steatosis in chronic hepatitis B”. Digestive Liver Disease8 (2017): 910-917.
11. Liang J., et al. “A Noninvasive Score Model for Prediction of NASH in Patients with Chronic Hepatitis B and Nonalcoholic Fatty Liver Disease”. Biomed Research International (2017): 8793278.
12. Shiha G., et al. “Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update”. Hepatology International1 (2017): 1-30.
13. Lee S and Kim DY. “Non-invasive diagnosis of hepatitis B virus-related cirrhosis”. World Journal of Gastroenterology2 (2014): 445-459.
14. Xiao G., et al. “Comparison of diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis-4 index for detecting liver fibrosis in adult patients with chronic hepatitis B virus infection: a systemic review and meta-analysis”. Hepatology1 (2015): 292-302.
15. Shin WG., et al. “Aspartate aminotransferase to platelet ratio index (APRI) can predict liver fibrosis in chronic hepatitis B”. Digestive Liver Disease 40 (2008): 267-274.
16. Kim BK., et al. “Noninvasive models to predict liver cirrhosis in patients with chronic hepatitis B”. Liver International7 (2007): 969-976.
17. Singh S., et al. “American Gastroenterological Association Institute Technical Review on the Role of Elastography in Chronic Liver Diseases”. Gastroenterology6 (2017): 1544-1577.
18. Sharma P., et al. “Usefulness of transient elastography by FibroScan for the evaluation of liver fibrosis”. Indian Journal of Gastroenterology 5 (2014): 445-451.
19. Afdhal NH., et al. “Accuracy of fibroscan, compared with histology, in analysis of liver fibrosis in patients with hepatitis B or C: a United States multicenter study”. Clinical Gastroenterology and Hepatology 4 (2015): 772-9.e1-e3.
20. Bota S., et al. “Meta-analysis: ARFI elastography versus transient elastography for the evaluation of liver fibrosis”. Liver International8 (2013): 1138-1147.
21. Lee GM., et al. “Quantitative Measurement of Hepatic Fibrosis with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging in Patients with Chronic Hepatitis B Infection: A Comparative Study on Aspartate Aminotransferase to Platelet Ratio Index and Fibrosis-4 Index”. Korean Journal of Radiology3 (2017): 444-451.
22. Li Y., et al. “Development of algorithms based on serum markers and transient elastography for detecting significant fibrosis and cirrhosis in chronic hepatitis B patients: Significant reduction in liver biopsy”. Hepatol Res. 46.13 (2016): 1367-1379.
23. Ding D., et al. “FibroScan, aspartate aminotransferase and alanine aminotransferase ratio (AAR), aspartate aminotransferase to platelet ratio index (APRI), fibrosis index based on the 4 factor (FIB-4), and their combinations in the assessment of liver fibrosis in patients with hepatitis B”. International Journal of Clinical and Experimental Medicine11 (2015): 20876-82.
24. Jia J., et al. “Transient elastography compared to serum markers to predict liver fibrosis in a cohort of Chinese patients with chronic hepatitis B”. Journal of Gastroenterology Hepatology4 (2015): 756-762.
25. Chang PE., et al. “Prospective evaluation of transient elastography for the diagnosis of hepatic fibrosis in Asians: comparison with liver biopsy and aspartate transaminase platelet ratio index”. Alimentary Pharmacology and Therapeutics 1 (2008): 51-61.
26. Cheng J., et al. “Validation of Ten Noninvasive Diagnostic Models for Prediction of Liver Fibrosis in Patients with Chronic Hepatitis B”. PLoS One12 (2015): e0144425.
27. Ratziu V., et al. “Sampling variability of liver biopsy in nonalcoholic fatty liver disease”. Gastroenterology7 (2005): 1898-1906.
28. Guido M., et al. “Chronic viral hepatitis: the histology report”. Digestive Liver Disease 43 (2011): S331-343.
29. Marcellin P., et al. “Non-invasive assessment of liver fibrosis by stiffness measurement in patients with chronic hepatitis B”. Liver International2 (2009): 242-247.
30. Chan HL., et al. “Alanine aminotransferase-based algorithms of liver stiffness measurement by transient elastography (Fibroscan) for liver fibrosis in chronic hepatitis B”. Journal of Viral Hepatitis1 (2009): 36-44.
31. European Association for Study of Liver Asociacion Latinoamericana para el Estudio del Higado. “EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis”. Journal of Hepatology1 (2015): 237-264.
32. Kwo PY., et al. “ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries”. American Journal of Gastroenterology 1 (2017): 18-35.
33. Sandrin L., et al. “Shear elasticity probe for soft tissues with 1-D transient elastography”. IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control 4 (2002): 436-446.
34. Cai YJ., et al. “A diagnostic algorithm for assessment of liver fibrosis by liver stiffness measurement in patients with chronic hepatitis B”. Journal of Viral Hepatitis (2017).
35. Wang Y., et al. “Controlled attenuation parameter for assessment of hepatic steatosis grades: a diagnostic meta-analysis”. International Journal of Clinical and Experimental Medicine10 (2015): 17654-17663.
36. Baig S. “Gender disparity in infections of Hepatitis B virus”. Journal of College of Physicians and Surgeons Pakistan 9 (2009): 598-600.
37. Guardiola Arévalo A., et al. “Characteristics and course of chronic hepatitis B e antigen-negative infection”. Gastroenterology Hepatology2 (2017): 59-69.
38. Lim CT and Kumar R. “Hepatitis B and concomitant hepatic steatosis”. Annals of Translational Medicine's 3 (2017): 38.
39. Fan JG and Chitturi S. “Hepatitis B and fatty liver: causal or coincidental?” Journal of Gastroenterology Hepatology5 (2008): 679-681.

Citation

Citation: Shah Jayshri A., et al. “Role of Fibroscan and Non Invasive Markers to Assess Hepatic Fibrosis and Steatosis at Initial Presentation of Patients with Hepatitis B". Acta Scientific Gastrointestinal Disorders 3.8 (2020): 16-23.

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Copyright: © 2020 Shah Jayshri A., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.