Validation of Hepascore as a Predictor of Liver Fibrosis in Patients with Chronic Hepatitis C Infection

Abstract

Introduction. Liver biopsy is an invasive determinator for hepatic fibrosis. Serum biomarkers can probably be used as an alternative to liver biopsy in assessment of the degree of fibrosis in patients with chronic Hepatitis C. Method. Eighty patients with chronic Hepatitis C were included in the study using simple nonrandom sampeling metod. After fulfillment of liver biopsy, the patients were categorized according to the METAVIR Scoring system. The Hepascore algorithm is computed based on age, sex, and the serum levels of total bilirubin, δ-glutamyl transferase, α2-Macroglobulin, and hyaluronic acid. The spearman and ROC tests were used. Results. According to the liver biopsy results, 12, 25, 20, 7 and 16 patients had F0, F1, F2, F3, and F4, respectively. With regard to the 0.34 cut-off point Hepascore had 67%, 56%, 64%, and 56% sensitivity, specificity, respectively, positive prediction value (PPV), and negative prediction value (NPV), respectively, for diagnosis of significant fibrosis. For a Hepascore cut-off point 0.61, sensitivity, specificity, respectively, PPV and NPB 82%, 86%, 70%, and 92% in diagnosis of severe fibrosis. For a Hepascore cut-off point 0.84, sensitivity, specificity, PPV and NPB were respectively 100%, 97%, 89%, and 100% for diagnosis of cirrhosis. Conclusion. Hepascore has a high value in diagnosis of the level of fibrosis, particularly cirrhosis. Therefore, it can be used for primary screening of patients to determine the need for liver biopsy.

Discrimination of fibrotic staging of chronic hepatitis C using multiple fibrotic markers

“…Recently, several studies were published about estimation of hepatitis stages, using one or more serum biomarkers. Discriminant functions or multivariate analyses demonstrated that approximately 60–90% of patients with chronic hepatitis C were correctly classified as mild hepatitis and severe hepatitis with advanced fibrosis . The usefulness of the discriminant functions was, however, less valuable up to the present time for a few reasons.…”

“…Discriminant functions or multivariate analyses demonstrated that approximately 60-90% of patients with chronic hepatitis C were correctly classified as mild hepatitis and severe hepatitis with advanced fibrosis. [5][6][7][8][9][10][11][12][13][14][15][16] The usefulness of the discriminant functions was, however, less valuable up to the present time for a few reasons. First, these functions were made for the purpose of discrimination of severe hepatic fibrosis from mild fibrosis, and four histological classifications (F1, F2, F3 and F4) were selected in almost of the studies.…”

Hyaluronic acid as a non-invasive biomarker of liver fibrosis

“…In particular, ELF between 9.8-11.3 will likely exclude cirrhosis, as well as lack of fibrosis, deeming a liver biopsy often necessary to establish the degree of fibrosis (44). In contrast, Kalantari et al (34) found higher HA levels in females compared to males, although patients were not stratified by age group or fibrosis stage, both of which were also independent predictors of HA levels. Both HA and the ELF score were lower in patients with sustained response compared to those without sustained response in a cohort of chronic HCV patients treated with pegylated interferon plus ribavirin (35).…”

Non-invasive diagnosis of liver fibrosis in chronic hepatitis C

“…It was devised in a cohort of chronic HCV patients [66] and further validated in several studies [67][68][69][70][71][72] . An interesting advantage of Hepascore ® is that it can be totally automated using a single analyzer and only one serum sample [69] .…”