Comparison of Invasive and Non-Invasive Liver Fibrosis Indicators in Chronic Hepatitis B Patients

Abstract

Background: Liver biopsy is the gold standard for staging fibrosis. This procedure is quite difficult, has complications and is invasive. Various scores were defined using biochemical tests to define the fibrosis stage and it was aimed to define the fibrosis stage without biopsy. Materials and Methods: The study included 156 patients who were followed up with a diagnosis of chronic viral hepatitis B and had a liver biopsy performed at the Infectious Diseases and Clinical Microbiology Clinic of Harran University Faculty of Medicine Hospital between 2010 and 2022. The patients were divided into two groups according to the ISHAK scoring system. Patients with no fibrosis and mild fibrosis were grouped as F0 (Stage 0, 1, 2), and patients with moderate-severe fibrosis were grouped as F1 (Stage 3, 4, 5). FIB-4, APRI, AAR, KING, AGAP, FIBROQ, FI, FCI, GPR, GUCI and ALBI scores were calculated using age, gender, complete blood count and some biochemical parameters. Results: 74,4% (n = 116) of the patients were in the F0 group and 25,6% (n = 40) were in the F1 group. The median age of the patients was 39.00 [49-31] years. 89 of the patients were male (57,1%) and 67 (42,9%) were female. While the difference between FIB-4(p<0.001), APRİ(p<0.001), KING(p<0.001), AGAP(p<0.001) and GUCI(p<0.001) scores was found to be statistically significant, no significant difference was found between other scores. According to ROC analysis, the non-invasive score with the highest diagnostic performance was GUCI (0.796), and the cut-off value for this score was ≥0.70. Conclusions: In the study, GUCI was found to be a useful score, especially in terms of diagnostic performance. Considering the negative effects of liver biopsy, such as being an invasive procedure and carrying the risk of complications, it can be said that non-invasive scoring systems will be useful in predicting fibrosis.

Keywords

• Chronic HBV
• Fibrosis
• Non-invasive
• Hepatitis
• GUCI

Kronik Hepatit B Hastalarında İnvaziv Ve Non-İnvaziv Karaciğer Fibrozis Göstergelerinin Karşılaştırılması

Abstract

Amaç: Karaciğer biyopsisi fibrozisin evrelenmesi için altın standarttır. Bu işlem oldukça güç, kompli-kasyonları olan ve invaziv bir işlemdir. Bu çalışmada kronik viral hepatit B tanılı hastalarda karaciğer fibrozisini öngörmede kullanılan non-invaziv yöntem sonuçlarının karaciğer biyopsi sonuçlarıyla karşılaştırılması amaçlandı. Materyal ve metod: Çalışmaya 2010-2022 yılları arasında Harran Üniversitesi Tıp Fakültesi Hastanesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji kliniğinde kronik viral hepatit B tanısıyla takip edilen ve karaciğer biyopsisi yapılmış olan 156 hasta dahil edildi. İSHAK skorlama sistemine göre hastalar iki gruba ayrıldı. Fibrozisi olmayan ve hafif fibrozisi olan hastalar F0 (Evre 0, 1, 2), orta-ağır fibrozisi olan hastalar ise F1 (Evre 3, 4, 5) olarak gruplandırıldı. Yaş, cinsiyet, hemogram ve biyokimyasal bazı parametreler kullanılarak FIB-4, APRI, AAR, KING, AGAP, FIBROQ, FI, FCI, GPR, GUCI ve ALBI skorları hesaplandı. Bulgular: Hastaların %74,4’ü (n = 116) F0, %25,6’sı (n=40) ise F1 grubunda yer alıyordu. Hastaların yaş medyanı 39.00 [49-31] yıldı. Hastaların 89’u erkek (%57,1) ve 67’si (%42,9) kadındı. FIB-4 (p<0.001), APRİ (p<0.001), KING (p<0.001), AGAP (p<0.001) ve GUCI (p<0.001) skorlamaları arasın-daki fark istatistiksel açıdan anlamlı bulunurken diğer skorlamalar arasında anlamlı farklılık saptan-madı. ROC analizine göre tanı performansı en yüksek olan non-invaziv skor GUCI (0.796) idi ve bu skor için kesme değeri ≥0.70 olarak bulundu. Sonuç: Çalışmada özellikle tanısal performans bakımından GUCI yararlı bir skor olarak tespit edildi. Karaciğer biyopsisinin invaziv bir işlem olması, komplikasyon riskini taşıması gibi negatif etkileri göz önünde bulundurulduğunda non-invaziv skorlama sistemlerinin fibrozisi tahmin etmede yararlı olacağı söylenebilir.

Keywords

• Kronik HBV
• Fibrozis
• Non-invaziv
• Hepatit
• GUCI

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