Background:  The gold standard for assessment of liver fibrosis is liver biopsy, which is invasive and may rarely results in complications. Therefore, searching for alternative, accurate non-invasive parameters to evaluate the presence and degree of liver fibrosis is needed for prediction of prognosis and planning treatment of chronic hepatitis C (CHC) patients.

 

Aim: To examine if serum laboratory markers combined with other sonographic and Doppler parameters could accurately predict the stage of liver fibrosis amongst Egyptian hepatitis C (HCV) infected patients.

 

Patients and Methods: Sixty-nine HCV infected persons were consecutively recruited from Sohag and Assiut University hospitals. All patients had complete clinical, abdominal ultrasound and Doppler examinations. Testing for serum fibrosis markers in sera collected at the time of liver biopsy. Biopsies were scored according to Batts-Ludwig scoring system (stage 0, no fibrosis to stage IV, cirrhosis). Fibrosis was evaluated against age, platelet count (PLT),  alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST to platelet ratio (APRI), total billirubin (T.Bil.), prothrombin time and concentration (PT&PC), hyaluronic acid (HA), YKL-40, α2-macroglobulin (α2M), and tissue inhibitor metalloprotease1 (TIMP1). The ultrasonographic and Doppler examinations included liver size, echopattern, surface, caudate lobe diameter/right lobe diameter (CLD/RLD), spleen length, spleen diameter at the hilum, portal vein (PV) diameter, PV cross sectional area, PV velocity, hepatic artery resistive index (HARI), and congestion index (CI).

 

Results:  42 (60.9%) patients (group 1) had no/mild hepatic fibrosis (stage 0-I), and 27 (39.1%) patients had moderate/severe hepatic fibrosis (stage II-III).  None of the included patients was in stage IV. A significant relationship was found between fibrosis stage and age (p=0.002), PLT (p=0.0001), AST (p=0.01), PC (p=0.0003), APRI (p=0.028), α2M (p=<0.05), HA (p=0.02), hepatomegaly (p=0.031), CLD/RLD (p=0.005), coarse echopattern (p=0.001), nodular surface (p=0.012), PV cross sectional area (p=0.04), PV velocity (p=0.0004), spleen diameter (p=0.0001) and CI (p=0.005). By multiple logistic regression analysis an index combining PLT, PC, APRI, HA, α2M, PV velocity and  spleen thickness could  differentiate the presence or absence of severe fibrosis at a cut-off>0.24 with high sensitivity, specificity, PPV and NPV (96.30%, 87.80%, 83.9% and 97.3%) and high diagnostic accuracy (AUROC=0.9616).

 

Conclusion: The staging of liver fibrosis could be predicted by simple non invasive markers. The combination PLT, PC, APRI, HA, α2M, PV velocity, and spleen diameter in our index has a high diagnostic performance for the diagnosis of hepatic fibrosis. This could reduce the number of unnecessary liver biopsies.