NONINVASIVE PARAMETERS AND STAGING OF LIVER FIBROSIS IN CHRONIC HEPATITIS C PATIENTS
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Keywords

Hepatitis C (MeSH)
Fibrosis (MeSH)
Liver Cirrhosis (MeSH)
FibroScan (Non-MeSH)
Biochemical Markers (MeSH)
Aspartate Aminotransferase (MeSH)
Alanine Transaminase (MeSH)
gamma-Glutamyltransferase (MeSH)
Haptoglobins (MeSH)
Alkaline Phosphatase (MeSH)

How to Cite

Rahim, A., Shafqat, T., Nazli, R., Lutfullah, G., Fatima, S., & Zubair, A. (2019). NONINVASIVE PARAMETERS AND STAGING OF LIVER FIBROSIS IN CHRONIC HEPATITIS C PATIENTS. KHYBER MEDICAL UNIVERSITY JOURNAL, 11(1), 26-31. https://doi.org/10.35845/kmuj.2019.18561

Abstract

OBJECTIVES: To use biochemical parameters and FibroScan as noninvasive tool in determination of various stages of liver fibrosis in chronic hepatitis C virus (HCV) patients.
METHODS: Total 759 participants (609 chronic HCV patients and 150 normal healthy controls) were recruited from Lady Reading Hospital and Al-Hayat Medical Center, Dabgri garden, Peshawar, Pakistan and analyzed for biochemical markers from February 2015 to January 2017. On the basis of liver stiffness, 609 HCV patients were categorized in 05 groups as per FibroScan findings that include patients with no fibrosis, mild fibrosis, moderate fibrosis, severe fibrosis and cirrhosis. Only those HCV patients who showed presence of HCV RNA (PCR assay) in serum were included in this study. HCV patients who were co-infected with Hepatitis B virus and HIV were excluded from this study.
RESULTS: Advance staged disease patients with severe liver fibrosis and cirrhosis showed elevated level of aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), AST/ALT, total bilirubin and lower level of albumin and haptoglobinas compared to controls and were found statistically significant (P<0.01). Patients group with cirrhosis showed elevated level of AST, GGT, ALP, AST/ALT and total bilirubin when compared to patients group with no liver complications and were statistically significant (P<0.01). Albumin and haptoglobin were significantly lower (P<0.05) in cirrhotic patients compared to those without liver complications.
CONCLUSION: Combination of FibroScan and routinely available biochemical parameters are helpful in identifying liver fibrosis and cirrhosis in chronic HCV patients.

https://doi.org/10.35845/kmuj.2019.18561
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References

REFERENCES:

Afridi SQ, Ali MM, Awan F, Zahid MN, Afridi IQ, Afridi SQ, et al. Molecular epidemiology and viral load of HCV in different regions of Punjab, Pakistan. Virol J 2014;11:24. DOI: 10.1186/1743-422X-11-24.

Afridi SQ, Zahid MN, Shabbir MZ, Hussain Z, Mukhtar N, Tipu MY, et al. Prevalence of HCV genotypes in district Mardan. Virology J 2013;10:90. DOI: 10.1186/1743-422X-10-90.

Brant LJ, Hurrelle M, Balogun MA, Klapper P, Ahmad F, Boxall E, et al. Sentinel laboratory surveillance of hepatitis C antibody testing in England: understanding the epidemiology of HCV infection. Epidemiol Infect 2007 Apr;135(3):417-26. DOI: 10.1017/S0950268806006832.

Khan MH, Farrell GC, Byth K, Lin R, Weltman M, George J, et al. Which patients with hepatitis C develop liver complications? Hepatology 2000;31(2):513-20. DOI: 10.1002/hep.510310236.

Kuo I, Hassan SU, Galai N, Thomas DL, Zafar T, Ahmed MA, et al. High seroprevalence and HIV drug use risk behaviors among injection drug users in Pakistan. Harm Reduct J 2006;3:26. DOI: 10.1186/1477-7517-3-26.

Bruce MG, Bruden D, McMahon BJ, Christensen C, Homan C, Sullivan D, et al. Hepatitis C Infection in Alaska Natives with persistently normal, persistently elevated or fluctuating alanine aminotransferase levels. Liver Int 2006;26(6):643-9. DOI: 10.1111/j.1478-3231.2006.01281.x.

Thomas L. Alanine aminotransferase (ALT), Aspartate aminotransferase (AST). Clinical Laboratory Diagnostics. 1st ed. 1999. TH-Books Verlagsgesellschaft Frankfurt. p. 55-65.

Moss DW, Henderson AR. Clinical enzymology. In: Clinical Chemistry. 3rd ed. 1999. WB Saunders Company, Philadelphia. p. 617-721.

Singhal A, Jayaraman M, Dhanasekaran DN, Kohli V. Molecular and serum markers in hepatocellular carcinoma: predictive tools for prognosis and recurrence. Crit Rev Oncol Hematol 2012;82(2):116-40. DOI: 10.1016/j.critrevonc.2011.05.005.

Fattovich G, Giovanna G, Degos F, Tremolada F, Diodati G, Almasio P, et al. Morbidity and mortality in compensated cirrhosis type C: a retrospective follow-up study of 384 patients. Gastroenterology 1997;112(2):463-72. DOI:10.1053/gast.1997.v112.pm9024300

Trayhurn P, Wood IS. Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br J Nutr 2004;92(03):347-55. DOI: 10.1079/BJN20041213.

Boursier J, Vergniol J, Guillet A, Hiriart JB, Lannes A, Le-Bail B, et al. Diagnostic accuracy and prognostic significance of blood fibrosis tests and liver stiffness measurement by FibroScan in non-alcoholic fatty liver disease. J Hepatol 2016;65(3):570-8. DOI: 10.1016/j.jhep.2016.04.023.

Talwalkar JA, Kurtz DM, Schoenleber SJ, West CP, Montori VM. Ultrasound based treatment transient elastography for the detection of hepatic fibrosis; systemic review and meta analysis. Clin Gastroenterol Hepatol 2007;5(10):1214-20. DOI: 10.1016/j.cgh.2007.07.020.

Fridrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, et al. Performance of transient elastography for the staging of liver fibrosis: A meta analysis. Gastroenterology 2008;134(4):960-74. DOI: 10.1053/j.gastro.2008.01.034.

Saito H, Tada S, Nakamoto N, Kitamura K, Horikawa H, Kurita S, et al. Efficacy of non-invasive elastometry on staging of hepatic fibrosis. Hepatol Res 2004;29(2):97-103. DOI: 10.1016/j.hepres.2004.03.007.

Ziol M, Handra‚ÄźLuca A, Kettaneh A, Christidis C, Mal F, Kazemi F, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology 2005;41(1):48-54. DOI: 10.1002/hep.20506.

Sandrin L, Tanter M, Gennisson J L, Catheline S, Fink M. Shear elasticity probe for soft tissues with 1-D transient elastography. IEEE Trans Ultrason Ferroelectr Freq Control 2002;49(4):436-46.

Vilar-Gomez E, Chalasani N. Non-invasive assessment of non-alcoholic fatty liver disease: Clinical prediction rules and blood-based biomarkers. J Hepatol 2018;68(2):305-15. DOI: 10.1016/j.jhep.2017.11.013.

Forns X, Ampurdanes S, Sanchez-Tapias JM, Guilera M, Sans M, Sanchez-Fueyo A, et al. Long term follow up of chronic hepatitis C in patients diagnosed at a tertiary-care center. J Hepatol 2001; 35(2):265-71. DOI: 10.1016/S0168-8278(01)00088-5.

Oberti F, Valsesia E, Pilette C, Roussel MC, Bedossa P, Aube C, et al. Non invasive diagnosis of hepatic fibrosis or cirrhosis. Gastroenterology 1997;113(5):1609-16. DOI: 10.1053/gast.1997.v113.pm9352863.

Ni H, Soe HHKS, Htet A. Determinants of abnormal liver function tests in diabetes patients in Myanmar. Int J Diabetes Res 2012;1(3):36-41. DOI: 10.5923/j.diabetes.20120103.02.

Bates SM. D-Dimer Assays in Diagnosis and Management of Thrombotic and Bleeding Disorders. Semin Thromb Hemost 2012;38(7):673-82. DOI: 10.1055/s-0032-1326782.

Spencer K, Price CP. Influence of reagent quality and reaction condition on the determination of serum albumin by bromocresol green dye-binding method. Ann Clin Biochem 1977;14(2):105-15. DOI: 10.1177/000456327701400119.

Hyder M, Hasan M, Mohieldein AH. Comparative levels of ALT, AST, ALP and GGT in Liver associated diseases. Euro J Exp Bio 2013;3(2):280-84.

Daniel PK, Isselbacher KJ. Cirrhosis and its complications. In Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, editors. Harrison's Principles of Internal Medicine. 14th ed. 1998. McGraw-Hill Medical Publishing Division, New York. p 1704-10.

Sulkowski MS, Mehta SH, Torbenson MS, Higgins Y, Brinkley C, de Oca RM, et al. Rapid fibrosis progression among HIV/hepatitis C virus-co-infected adults. AIDS 2007;21(16):2209-16. DOI: 10.1097/QAD.0b013e3282f10de9.

Okuda M, Li K, Beard MR, Showalter LA, Scholle F, Lemon SM, et al. Mitochondrial injury, oxidative stress, and anti oxidant gene expression are induced by hepatitis C virus core protein. Gastroenterology 2002;122(2):366-75. DOI:10.1053/gast.2002.30983

Williams AL, Hoofnagle JH. Ratio of serum aspartate to alanine aminotransferase in chronic hepatitis. Relationship to cirrhosis. Gastroenterology 1988;95(3):734-9. DOI:10.1016/S0016-5085(88)80022-2.

Assay N, Minuk GY. Serum aspartate but not alanine aminotransferase levels help to predict the histological features of chronic hepatitis c viral infections in adults. Am J Gastroenterol 2000;95(6):1545-50. DOI: 10.1111/j.1572-0241.2000.02027.x.

Inglesby TV, Rai R, Astemborski J, Gtuskin L, Nelson KE, Vlahov D, et al. A prospective, community-based evaluation of liver enzymes in individuals with hepatitis C after drug use. Hepatology 1999;29(2):590-6. DOI: 10.1002/hep.510290219.

Lutfullah G., Nazli R, Akhtar T. Serum Alanine Aminotransferase levels in Hepatitis C patients in Teaching Hospitals of Peshawar. J Chem Soc Pakistan 2008;30(1):106-9.

Forns X, Ampurdanes S, Llovet JM, Aponte J, Quinto L, Martinez-Bauer E, et al. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology 2002;36(4 Pt 1):986-92. DOI: 10.1053/jhep.2002.36128.

Pohl A, Behling C, Oliver D, Kilani M, Monson P, Hassanein. T. Serum aminotransferase levels and platelet counts as predictors of degree of fibrosis in chronic hepatitis C virus infection. Am J Gastroenterol 2001;96(11):3142-6. DOI: 10.1111/j.1572-0241.2001.05268.x.

Bonacini M, Hadi G, Govindarajan S, Lindsay KL. Utility of a discriminant score for diagnosing advanced fibrosis or cirrhosis in patients with chronic Hepatitis C virus infection. Am J Gastroenterol 1997;92(8):1302-4.

Poynard T, de Ledinghen V, Zarski JP, Stanciu C, Munteanu M, Vergniol J, et al. Relative performances of Fibro Test, FibroScan, and biopsy for the assessment of the stage of liver fibrosis in patients with chronic hepatitis C: a step toward the truth in the absence of a gold standard. J Hepatol 2012;56(3):541-8. DOI: 10.1016/j.jhep.2011.08.007.

Contreras RH, Callewaert NLM. Serum marker for measuring liver fibrosis. US Patent 2007;7244619.

Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 2007;45(4):846-54. DOI: 10.1002/hep.21496.

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