Non‐invasive fibrosis score for hepatitis delta

Lutterkort, G.L.; Wranke, A.; Yurdaydın, Cihan; Budde, Eva; Westphal, Max; Lichtinghagen, Ralf; Stift, Judith; Bremer, Birgit; Hardtke, Svenja; Keskın, Onur; İdilman, Ramazan; Koch, Armin; Manns, Michael P.; Dienes, Hans Peter; Wedemeyer, Heiner; Heidrich, B.

doi:10.1111/liv.13205

Cited by 51 publications

(69 citation statements)

References 36 publications

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“…This prevalence was up to 40% in a European study that included genotype-1 HDV patients [19] and up to 53% in multi-center study in Italy [1]. The present study reported a higher prevalence of severe liver disease in chronic HDV infection than those series.…”

Section: Discussioncontrasting

confidence: 41%

“…However, these serological biomarkers use platelet count in theirs formulas and most patients with chronic HDV infection have splenomegaly and hypersplenism leading to thrombocytopenia that might overestimate liver fibrosis by methods. In addition, those serological markers had a not satisfactory diagnostic performance (AUROC < 0.80) in HDV infected patients using liver biopsy as the reference [19]. The same authors have proposed a new biomarker, Delta Fibrosis Score, that uses levels of cholinesterase, GGT and albumin combined to age, for prediction of liver fibrosis in HDV infection.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and predictors for compensated Advanced Chronic Liver Disease (c-ACLD) in patients with chronic Hepatitis Delta Virus (HDV) infection

et al. 2017

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ObjectiveThe study aimed to evaluate the prevalence and predictor factors for compensated advanced chronic liver disease (c-ACLD) in patients with hepatitis Delta virus (HDV) infection.MethodsThis cross-sectional study included consecutive HDV-infected patients defined by positive anti-HDV. Patients with hepatitis C coinfection, liver transplantation or presence of conditions that limit liver (LSM) or spleen stiffness measurement (SSM) were excluded. Blood tests, abdominal ultrasound, SSM and LSM by transient elastography (FibroScan®) were performed at the same day. Alcohol consumption was quantified using the AUDIT score and c-ACLD was defined by LSM ≥ 15 kPa performed by an experimented operator blinded for clinical and laboratory data.Results101 patients were eligible and few patients were excluded due to negative anti-HDV (n = 7), hepatitis C coinfection (n = 2), liver transplantation (n = 10) and limitation for LSM or SSM (n = 5). Therefore, 77 patients [61% male, age = 43 (IQR,36–52) years] were included. The prevalence of c-ACLD was 57% (n = 44/77). Patients with c-ACLD had a higher rate of detectable HBV viral load (p = 0.039), higher levels of transaminases, GGT, alkaline phosphatases, total bilirubin and INR (p<0.001 for all), as well as lower platelet count and albumin levels (p>0.001 for both) compared to those without c-ACLD. Patients with c-ACLD had higher SSM [65.2 (IQR,33.8–75.0) vs 21.8 (16.5–32.0) kPa; p<0.001] and higher splenic volume [475 (IQR,311–746) vs 154 (112–283) cm3; p<0.001] compared to those without. Detectable HBV viral load (>10 UI/ml), alkaline phosphatase (per IU/L) and GGT levels (per IU/L) were independently associated with c-ACLD in all multivariate models. Splenic volume [per cm3,OR = 1.01 (95%CI,1.01–1.02);p = 0.002], SSM [per kPa, OR = 1.04 (1.01–1.07);p = 0.012] and splenomegaly [yes vs no,OR = 28.45 (4.42–182.95);p<0.001] were independently associated with c-ACLD.ConclusionsThe prevalence of c-ACLD was high in patients with chronic HDV infection in western Amazon basin. HBV viral load, liver enzymes and splenic features can be used to predict severe liver disease in HDV-infected patients.

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Section: Discussioncontrasting

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Prevalence and predictors for compensated Advanced Chronic Liver Disease (c-ACLD) in patients with chronic Hepatitis Delta Virus (HDV) infection

et al. 2017

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“…However, in a recent piece(6) reporting on 100 subjects from HIDIT-1, similar results were described. Despite these low numbers, it should be noted that the WHO has estimated that only 5% of HBsAg positive individuals are co-infected with HDV globally and both the US FDA and European Medicines Agency (EMA) consider HDV to be a rare disease allowing novel therapies in this field for orphan drug designation.…”

supporting

confidence: 72%

Letter: need to re-evaluate non-invasive markers for staging fibrosis in chronic delta hepatitis - authors’ reply

Takyar

Koh

2017

Aliment Pharmacol Ther

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“…Our study shows that the combined quantitative profiling of HBV and HDV markers identifies specific patterns associated with activity and stage of CHD and confirms the relevance of an underlying transcriptionally active HBV infection for HDV pathogenicity, in spite of the inhibition on HBV replication exerted by HDV. At present, in clinical practice, the best prognostic scores to identify candidates to antiviral therapy are based on algorithms using early markers of advanced fibrosis . Therefore, there is an unmet need to identify predictors of unfavourable disease outcome independent of markers which are already consequence of advanced liver fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Quantification of serum markers of hepatitis B (HBV) and Delta virus (HDV) infections in patients with chronic HDV infection

Ricco

Popa

Cavallone

et al. 2018

Journal of Viral Hepatitis

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The interplay between hepatitis B (HBV) and delta (HDV) viruses is complex and not always characterized during chronic HDV infection. We assessed the clinical usefulness of new quantitative assays for HBV and HDV serum markers in a retrospective cross-sectional study. Sera obtained from 122 HDV genotype 1 and HBV genotype D coinfected, anti-HIV-negative patients (71 males; median age 49.8 [21.7-66.9] years), recruited consecutively in two geographical areas (Italy 69 patients, Romania 53 patients) with different HBV and HDV epidemiology, were tested for HBsAg, HBV-DNA, HBcrAg, total anti-HBc, HDV-RNA, IgM and total anti-HDV using quantitative assays. Cirrhosis, which showed comparable prevalence in the two cohorts, was diagnosed in 97 of 122 (79.5%) patients. At multivariate analysis, cirrhosis was associated with lower total anti-HBc/IgM anti-HDV ratio (OR 0.990, 95% CI 0.981-0.999, P = .038), whereas disease activity was associated with higher total anti-HDV (OR 10.105, 95% CI 1.671-61.107, P = .012) and HDV-RNA levels (OR 2.366, 95% CI 1.456-3.844, P = .001). HDV-RNA serum levels showed a positive correlation with HBV-DNA (ρ = 0.276, P = .005), HBsAg (ρ = 0.404, P < .001) and HBcrAg (ρ = 0.332, P < .001). The combined quantitative profiling of HBV and HDV serum markers identifies specific patterns associated with activity and stage of chronic hepatitis D (CHD). HDV pathogenicity depends on the underlying active HBV infection in spite of the inhibition of its replication. HDV-RNA, IgM anti-HDV, total anti-HDV, total anti-HBc, HBsAg and HBcrAg serum levels qualify for prospective studies to predict progressive CHD and identify candidates to antiviral therapy.

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Non‐invasive fibrosis score for hepatitis delta

Cited by 51 publications

References 36 publications

Prevalence and predictors for compensated Advanced Chronic Liver Disease (c-ACLD) in patients with chronic Hepatitis Delta Virus (HDV) infection

Prevalence and predictors for compensated Advanced Chronic Liver Disease (c-ACLD) in patients with chronic Hepatitis Delta Virus (HDV) infection

Letter: need to re-evaluate non-invasive markers for staging fibrosis in chronic delta hepatitis - authors’ reply

Quantification of serum markers of hepatitis B (HBV) and Delta virus (HDV) infections in patients with chronic HDV infection

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