Assessment of The Performances of Hepatitis C Virus Viral Markers, Age-Platelet Index and Aspartate aminotransferase to Alanine Aminotransferase Ratio Scores, in Predicting Liver Histopathology

Year 2021, , 6 - 12, 29.01.2021

Ayfer Bakır , Mustafa Güney , Harun Erdal , Özlem Yavuz , Armağan Günal , Mustafa Gülşen , Mehmet Tevfik Yavuz

https://doi.org/10.46310/tjim.825814

Cited By: 1

Abstract

Introduction
This study aimed to reveal the utility of age-platelet (AP) index and aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), which are non-invasive markers, in patients with chronic Hepatitis C virus (HCV) infection in prediction of fibrosis and evaluate whether viral markers could be used for that purpose or not.
Methods
A total of treatment-naïve 49 patients with chronic HCV who underwent liver biopsy were included in this retrospective study. Anti-HCV S/CO and HCV-RNA viral load (copy/ml) values measured simultaneously with biopsy were determined. AP index and AAR score were calculated and compared.
Results
Staging of liver biopsy samples of 49 HCV patients was assessed. Comparable diagnostic accuracies of AP index and AAR in prediction of significant fibrosis (F≥2) were showed with ROC curve analysis. The areas under the ROC (AUROCs) were 0.713 and 0.506 respectively. Diagnostic accuracy of API in prediction of significant fibrosis was superior to that of AAR (p=0.03). AUROC of HCV-RNA viral load in prediction of F≥2 was 0.531. Anti-HCV S/CO value (AUROC=0.464) was not found as a suitable marker in prediction of fibrosis.
Conclusions
AP index, AAR score and HCV viral load among non-invasive markers assessed in this study were useful in predicting significant fibrosis. Especially API was the most useful test in predicting significant fibrosis. AP index can be preferred in patients with near normal ALT values.

Keywords

liver fibrosis, non-invasive test, AST to ALT ratio (AAR), age-platelet (AP) index, HCV viral load, anti-HCV

Supporting Institution

No

References

• Bonino F, Oliveri F, Colombatto P, Coco B, Mura D, Realdi G, Brunetto MR. Treatment of patients with chronic hepatitis C and cirrhosis. J Hepatol. 1999;31 Suppl 1:197-200. doi: 10.1016/s0168-8278(99)80401-2.
• Kaserer K, Fiedler R, Steindl P, Müller CH, Wrba F, Ferenci P. Liver biopsy is a useful predictor of response to interferon therapy in chronic hepatitis C. Histopathology. 1998 May;32(5):454-61. doi: 10.1046/j.1365-2559.1998.00413.x.
• Davis GL, Lau JY. Factors predictive of a beneficial response to therapy of hepatitis C. Hepatology. 1997 Sep;26(3 Suppl 1):122S-127S. doi: 10.1002/hep.510260721.
• Wong JB, Bennett WG, Koff RS, Pauker SG. Pretreatment evaluation of chronic hepatitis C: risks, benefits, and costs. JAMA. 1998 Dec 23-30;280(24):2088-93. doi: 10.1001/jama.280.24.2088.
• Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001 Feb 15;344(7):495-500. doi: 10.1056/NEJM200102153440706.
• Cheung RC, Currie S, Shen H, Bini EJ, Ho SB, Anand BS, Hu KQ, Wright TL, Morgan TR; VA HCV-001 Study Group. Can we predict the degree of fibrosis in chronic hepatitis C patients using routine blood tests in our daily practice? J Clin Gastroenterol. 2008 Aug;42(7):827-34. doi: 10.1097/MCG.0b013e318046ea9a.
• Bonacini M, Hadi G, Govindarajan S, Lindsay KL. Utility of a discriminant score for diagnosing advanced fibrosis or cirrhosis in patients with chronic hepatitis C virus infection. Am J Gastroenterol. 1997 Aug;92(8):1302-4. PMID: 9260794.
• Hsieh YY, Tung SY, Lee K, Wu CS, Wei KL, Shen CH, Chang TS, Lin YH. Routine blood tests to predict liver fibrosis in chronic hepatitis C. World J Gastroenterol. 2012 Feb 28;18(8):746-53. doi: 10.3748/wjg.v18.i8.746.
• European Association for Study of Liver; Asociacion Latinoamericana para el Estudio del Higado. EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015 Jul;63(1):237-64. doi: 10.1016/j.jhep.2015.04.006.
• Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet. 1997 Mar 22;349(9055):825-32. doi: 10.1016/s0140-6736(96)07642-8.
• Lackner C, Struber G, Liegl B, Leibl S, Ofner P, Bankuti C, Bauer B, Stauber RE. Comparison and validation of simple noninvasive tests for prediction of fibrosis in chronic hepatitis C. Hepatology. 2005 Jun;41(6):1376-82. doi: 10.1002/hep.20717.
• Marcellin P, Asselah T, Boyer N. Fibrosis and disease progression in hepatitis C. Hepatology. 2002 Nov;36(5 Suppl 1):S47-56. doi: 10.1053/jhep.2002.36993.
• Poynard T, Bedossa P. Age and platelet count: a simple index for predicting the presence of histological lesions in patients with antibodies to hepatitis C virus. METAVIR and CLINIVIR Cooperative Study Groups. J Viral Hepat. 1997 May;4(3):199-208. doi: 10.1046/j.1365-2893.1997.00141.x.
• Massard J, Ratziu V, Thabut D, Moussalli J, Lebray P, Benhamou Y, Poynard T. Natural history and predictors of disease severity in chronic hepatitis C. J Hepatol. 2006;44(1 Suppl):S19-24. doi: 10.1016/j.jhep.2005.11.009.
• Peck-Radosavljevic M. Hypersplenism. Eur J Gastroenterol Hepatol. 2001 Apr;13(4):317-23. doi: 10.1097/00042737-200104000-00004.
• Dai CY, Ho CK, Huang JF, Hsieh MY, Hou NJ, Lin ZY, Chen SC, Hsieh MY, Wang LY, Chang WY, Yu ML, Chuang WL. Hepatitis C virus viremia and low platelet count: a study in a hepatitis B & C endemic area in Taiwan. J Hepatol. 2010 Feb;52(2):160-6. doi: 10.1016/j.jhep.2009.11.017.
• Guéchot J, Boisson RC, Zarski JP, Sturm N, Calès P, Lasnier E; ANRS HCEP 23 Fibrostar Group. AST/ALT ratio is not an index of liver fibrosis in chronic hepatitis C when aminotransferase activities are determinate according to the international recommendations. Clin Res Hepatol Gastroenterol. 2013 Nov;37(5):467-72. doi: 10.1016/j.clinre.2013.07.003.
• Fabris C, Smirne C, Toniutto P, Colletta C, Rapetti R, Minisini R, Falleti E, Pirisi M. Assessment of liver fibrosis progression in patients with chronic hepatitis C and normal alanine aminotransferase values: the role of AST to the platelet ratio index. Clin Biochem. 2006 Apr;39(4):339-43. doi: 10.1016/j.clinbiochem.2006.01.011.
• Okuda M, Li K, Beard MR, Showalter LA, Scholle F, Lemon SM, Weinman SA. Mitochondrial injury, oxidative stress, and antioxidant gene expression are induced by hepatitis C virus core protein. Gastroenterology. 2002 Feb;122(2):366-75. doi: 10.1053/gast.2002.30983.
• Fouad SA, Esmat S, Omran D, Rashid L, Kobaisi MH. Noninvasive assessment of hepatic fibrosis in Egyptian patients with chronic hepatitis C virus infection. World J Gastroenterol. 2012 Jun 21;18(23):2988-94. doi: 10.3748/wjg.v18.i23.2988.
• Lee YS, Yoon SK, Chung ES, Bae SH, Choi JY, Han JY, Chung KW, Sun HS, Kim BS, Kim BK. The relationship of histologic activity to serum ALT, HCV genotype and HCV RNA titers in chronic hepatitis C. J Korean Med Sci. 2001 Oct;16(5):585-91. doi: 10.3346/jkms.2001.16.5.585.
• Saleem N, Mubarik A, Qureshi AH, Siddiq M, Ahmad M, Afzal S, Hussain AB, Hashmi SN. Is there a correlation between degree of viremia and liver histology in chronic hepatitis C? J Pak Med Assoc. 2004 Sep;54(9):476-9. PMID: 15518372.
• Anand BS, Velez M. Assessment of correlation between serum titers of hepatitis C virus and severity of liver disease. World J Gastroenterol. 2004 Aug 15;10(16):2409-11. doi: 10.3748/wjg.v10.i16.2409.
• Zeuzem S, Schmidt JM, Lee JH, Rüster B, Roth WK. Effect of interferon alfa on the dynamics of hepatitis C virus turnover in vivo. Hepatology. 1996 Feb;23(2):366-71. doi: 10.1002/hep.510230225.
• Müller HM, Pfaff E, Goeser T, Kallinowski B, Solbach C, Theilmann L. Peripheral blood leukocytes serve as a possible extrahepatic site for hepatitis C virus replication. J Gen Virol. 1993 Apr;74 ( Pt 4):669-76. doi: 10.1099/0022-1317-74-4-669.
• Ballardini G, Manzin A, Giostra F, Francesconi R, Groff P, Grassi A, Solforosi L, Ghetti S, Zauli D, Clementi M, Bianchi FB. Quantitative liver parameters of HCV infection: relation to HCV genotypes, viremia and response to interferon treatment. J Hepatol. 1997 Apr;26(4):779-86. doi: 10.1016/s0168-8278(97)80242-5.