The Relationship Between Histopathological Stages of Liver Fibrosis and Albumin–Bilirubin Score in Chronic Hepatitis C Infection

Öz

Background and Aims: Many noninvasive biochemical indices have been developed to evaluate liver fibrosis. This study aimed to evaluate whether albumin–bilirubin score might be used as an alternative diagnostic method to performing liver biopsy to help predict liver fibrosis developing in patients with chronic hepatitis C virus infection and compare the score with other biochemical markers, for example, fibrosis-4 and aspartate aminotransferase-to-platelet ratio index (APRI) scores. Material and Methods: A total of 38 patients between the ages of 20 and 82 who had chronic hepatitis C virus infection and who underwent liver biopsy were evaluated. The patients were 27 males and 11 females. Albumin–bilirubin score, fibrosis-4, and aspartate aminotransferase-to-platelet ratio index score were calculated. Whether albumin–bilirubin score could differentiate fibrosis stage >2 from fibrosis stage ≥4 was evaluated by ROC analysis, and the score was compared with fibrosis-4 and aspartate aminotransferase-to-platelet ratio index scores. Results: The areas under the ROC curve for predicting fibrosis stage >2 and advanced liver fibrosis (fibrosis stage ≥4) according to the albumin–bilirubin score were 0.767 (95% Cl: 0.564–0.969) and 0.956 (95% Cl: 0.889–1.000), respectively, while they were 0.863 (95% Cl: 0.714–1.000) and 0.926 (95% Cl: 0.833–1.000) according to fibrosis-4 score and 0.667 (95% Cl: 0.450–0.884) and 0.640 (95% Cl: 0.378–0.901) according to aspartate aminotransferase-to-platelet ratio index score. Conclusions: According to the findings, it was concluded that albumin–bilirubin score could predict fibrosis stage >2 and advanced liver fibrosis (fibrosis stage ≥4). When the performance of albumin–bilirubin score in the prediction of fibrosis was compared with that of aspartate aminotransferase-to-platelet ratio index index and fibrosis-4 scores, the results were similar. However, fibrosis-4 score gave more reliable results in the prediction of fibrosis stage >2, while albumin–bilirubin score gave more reliable results in the prediction of advanced liver fibrosis (fibrosis stage ≥4).

Anahtar Kelimeler

• Hepatitis C virus,chronic hepatitis C,albumin–bilirubin score,aspartate aminotransferase-to-platelet ratio index,fibrosis-4 index

Kronik Hepatit C Enfeksiyonunda Karaciğer Histopatolojik Evreleri ile Albümin-Bilirübin Skoru Arasındaki İlişki

Öz

Giriş ve Amaç: Karaciğer fibrozunu değerlendirmek için birçok invaziv olmayan biyokimyasal indeksler geliştirilmiştir. Bu çalışmada allbümin-bilirübin skorunun kronik hepatit C virüs enfeksiyonunda gelişen karaciğer fibrozunun tahmininde karaciğer biyopsisine alternatif bir tanı yöntemi olup olamayacağının değerlendirilmesi ve diğer biyokimyasal belirteçler olan fibrozis-4 ve aspartat aminotransferaz/trombosit oran indeksi ile karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Yaş aralığı 20 ile 82 arasında değişen, karaciğer biyopsisi yapılmış, 27’si erkek ve 11’i kadın toplam 38 kronik hepatit C virüs enfeksiyonlu hasta değerlendirildi. Albümin-bilirübin, fibrozis-4 ve aspartat aminotransferaz/trombosit oran indeks skorları hesaplandı. Albümin-bilirübin skorunun fibrozis evre >2 ve >4’ü ayırt etme yeteneği ROC analizi ile değerlendirildi ve fibrozis-4 ve aspartat aminotransferaz/trombosit oran indeks skoru ile karşılaştırıldı. Bulgular: Albümin-bilirübin skorunun fibrozis evre >2 ve fibrozis evre ≥4 tanısı için ROC eğrisi altında kalan alan sırasıyla 0.767 (95% Cl: 0.564-0.969) ve 0.956 (95% Cl: 0.889-1.000) bulunurken, fibrozis-4 için 0.863 (95% Cl: 0.714-1.000) ve 0.926 (95% Cl: 0.833-1.000), aspartat aminotransferaz/ trombosit oran indeks skoru için 0.667 (95% Cl: 0.450-0.884) ve 0.640 (95% Cl: 0.378-0.901) idi. Sonuç: Bulgulara göre albümin-bilirübin skorunun fibrozis evre >2 ve ileri karaciğer fibrozunu (fibrozis evre >4) tahmin edebileceği değerlendirilmiştir. Albümin-bilirübin skorunun fibrozis tahminindeki performansı, aspartat aminotransferaz/trombosit oran indeks skoru ve fibrozis-4 ile karşılaştırıldığında sonuçların benzer olduğu ancak fibrozis evre >2 tahmininde fibrozis-4’ün, fibrozis evre ≥4’de ise aspartat aminotransferaz/ trombosit oran indeks skorunun daha güvenilir sonuç verdiği değerlendirilmiştir.

Anahtar Kelimeler

• Hepatit C virüs,kronik hepatit C,albümin-bilirübin skor,aspartat aminotransferaz/trombosit oran indeksi,fibrozis-4 indeksi

Kaynakça

1. 1. Polaris Observatory HCV Collaborators. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017;2:161-76. 2. Hepatitis C [Internet]. [cited 2020 Jan 30]. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c 3. Tozun N, Ozdogan O, Cakaloglu Y, et al. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study. Clin Microbiol Infect 2015;21:1020-6. 4. Leone N, Rizzetto M. Natural history of hepatitis C virus infection: from chronic hepatitis to cirrhosis, to hepatocellular carcinoma. Minerva Gastroenterol Dietol 2005;51:31-46. 5. Thein HH, Yi Q, Dore GJ, Krahn MD. Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta-regression. Hepatology 2008;48:418-31. 6. Sangiovanni A, Prati GM, Fasani P, et al. The natural history of compensated cirrhosis due to hepatitis C virus: A 17-year cohort study of 214 patients. Hepatology 2006;43:1303-10. 7. Fattovich G, Giustina G, Degos F, et al. Morbidity and mortality in compensated cirrhosis type C: a retrospective follow-up study of 384 patients. Gastroenterology 1997;112:463-72. 8. Lok AS, Seeff LB, Morgan TR, et al.; HALT-C Trial Group. Incidence of hepatocellular carcinoma and associated risk factors in hepatitis C-related advanced liver disease. Gastroenterology 2009;136:138-48. 9. Vallet-Pichard A, Mallet V, Nalpas B et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology. 2007;46:32-6. 10. Lidbury BA. Predicting liver disease post hepatitis virus infection: In silico pathology and pattern recognition. EBioMedicine 2018;35:10-11. 11. Agbim U, Asrani SK. Non-invasive assessment of liver fibrosis and prognosis: an update on serum and elastography markers. Expert Rev Gastroenterol Hepatol 2019;13:361-74. 12. World Health Organization. Guidelines for the Prevention, Care and Treatment of Persons with Chronic Hepatitis B Infection, 2015. 13. 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;63:237-64. 14. Shiha G, Ibrahim A, Helmy A, et al. Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update. Hepatol Int 2017;11:1-30. 15. Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol 2015;33:550-8. 16. Fujita K, Oura K, Yoneyama H, et al. Albumin-bilirubin score indicates liver fibrosis staging and prognosis in patients with chronic hepatitis C. Hepatol Res 2019;49:731-42. 17. Sterling RK, Lissen E, Clumeck N, et al; APRICOT Clinical Investigators. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006;43:1317-25. 18. Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003;38:518-26. 19. Cadranel JF, Nousbaum JB. Indications de la ponction biopsie hépatique au cours des maladies parenchymateuses diffuses du foie [Current trends in liver biopsy indications in chronic liver diseases]. Presse Med 2012;41:1064-70. 20. Trifan A, Stanciu C. Checkmate to liver biopsy in chronic hepatitis C? World J Gastroenterol 2012;18:5514-20. 21. Afdhal NH, Bacon BR, Patel K, et al. Accuracy of fibroscan, compared with histology, in analysis of liver fibrosis in patients with hepatitis B or C: a United States multicenter study. Clin Gastroenterol Hepatol 2015;13:772-9. 22. Chou R, Wasson N. Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review. [published correction appears in Ann Intern Med. 2013 Aug 20;159(4):308]. Ann Intern Med. 2013;158(11):807-20. 23. Vallet-Pichard A, Mallet V, Nalpas B, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology 2007;46:32-6. 24. Castera L, Pinzani M. Non-invasive assessment of liver fibrosis: are we ready? Lancet 2010;375:1419-20. 25. Castera L, Chouteau P, Hezode C, et al. Hepatitis C virus-induced hepatocellular steatosis. Am J Gastroenterol 2005;100:711-5. 26. Sebastiani G, Alberti A. Non invasive fibrosis biomarkers reduce but not substitute the need for liver biopsy. World J Gastroenterol 2006;12:3682-94. 27. Sebastiani G, Vario A, Guido M, et al. Stepwise combination algorithms of non-invasive markers to diagnose significant fibrosis in chronic hepatitis C. J Hepatol 2006;44:686-93. 28. Cordie A, Salama A, El-Sharkawy M, et al. Comparing the efficiency of Fib-4, Egy-score, APRI, and GUCI in liver fibrosis staging in Egyptians with chronic hepatitis C. J Med Virol 2018;90:1106-11. 29. Cheng CH, Chu CY, Chen HL et al. Subgroup analysis of the predictive ability of aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) for assessing hepatic fibrosis among patients with chronic hepatitis C. [published online ahead of print, 2019 Nov 29]. J Microbiol Immunol Infect. 2019;S1684-1182(19)30138-0.