Predicting progressive hepatic fibrosis stage on subsequent liver biopsy in chronic hepatitis C virus infection¹

Abstract

Retrospective cross-sectional studies indicate that 20% with chronic hepatitis C virus (HCV) infection become cirrhotic within 20 years. Known risk factors for advanced hepatic fibrosis include age at time of infection, male sex, excess alcohol consumption and cytokine polymorphisms. Prospective study to assess and identify factors predictive of change in hepatic fibrosis stage in chronic HCV infection by interval protocol liver biopsy was performed. One hundred and five patients with paired liver biopsy specimens separated by a mean 41 months were recruited from a cohort of 823 HCV carriers. Five per cent developed worsening hepatic fibrosis by more than two stages. In 43% there was no change in fibrosis stage. Excessive alcohol intake currently (P = 0.037) or previously (P = 0.07) predicted progression. In contrast, always having a normal alanine transaminase (P = 0.038) and always being negative in serum for HCV RNA (P =0.067) predicted no progression. Three models were developed to predict outcome. Progressive fibrosis was predicted by baseline fibrosis (P = 0.018), steatosis (P = 0.02) and age (P = 0.017). The rate of progressive fibrosis was predicted by baseline fibrosis (P = 0.0002), steatosis (P =0.039) and lobular inflammation (P = 0.09). Fibrosis stage on the second biopsy was predicted by baseline fibrosis alone (P = 0.01). The rate of progression varies widely. Alcohol misuse is an important co-factor. Progressive fibrosis can be predicted at first liver biopsy, where baseline fibrosis is most critical, allowing targeted therapy for those with early disease and a significant risk of progression.

APRI as a predictor of early viral response in chronic hepatitis C patients

“…Percutaneous liver biopsy has been the gold standard for grading and staging liver disease; recently however, non-invasive methods have been developed to determine hepatic fibrosis, such as transient elastog raphy, fibrotest, and the aspartate aminotransferase (AST) to platelet ratio index (APRI) [9][10][11] . APRI is one of several markers that have been proposed to measure liver fibrosis.…”

Alcohol and Hepatitis C

“…Another study also evaluated HCV carriers and found a relationship between steatosis and alcohol intake, though not to histological activity [49] . Collier et al [57] further found that in CHC patients, progressive fi brosis could be predicted by age, steatosis and baseline fi brosis, and that the latter two plus lobular infl ammation could also indicate the patient's fi brosis rate.…”

Steatosis in chronic hepatitis C: fuel for overproduction of oxidative stress?

“…Their observation is of interest because steatosis is considered to be a significant predictive factor for the progression of fibrosis in chronic hepatitis C patients, as evidenced by recent clinical studies. [11][12][13][14] reported that steatosis was the only independent predictive factor of progression of fibrosis in multivariate analysis. Collier et al 12 showed that the rate of progressive fibrosis was predicted by baseline fibrosis, steatosis, and lobular inflammation.…”

“…[11][12][13][14] reported that steatosis was the only independent predictive factor of progression of fibrosis in multivariate analysis. Collier et al 12 showed that the rate of progressive fibrosis was predicted by baseline fibrosis, steatosis, and lobular inflammation. In addition, the presence of steatosis is associated with resistance to antiviral therapy for HCV infection, 14 re-emphasizing the importance of steatosis in hepatitis C.…”