Hepatit B Enfeksiyonunda Karaciğer Histopatolojik Evreleri ile Albumin-Bilirubin Skoru Arasındaki İlişki

Year 2022, Volume: 24 Issue: 1, 60 - 66, 30.04.2022

Harun Erdal , Ayfer Bakır , Mustafa Güney , Armağan Günal , Mustafa Gülşen

https://doi.org/10.18678/dtfd.1055076

Abstract

Amaç: Bu çalışmada albümin-bilirubin (ALBI) skorunun belirgin karaciğer fibrozisini saptamada duyarlılık ve özgüllüğü araştırıldı ve bu bulgular fibrozis-4 (FIB-4) ve aspartat aminotransferaz/trombosit oranı indeksi (aspartate aminotransferase to platelet ratio index, APRI) skorları ile karşılaştırıldı.
Gereç ve Yöntemler: Bu çalışmaya toplam 69 hasta dahil edildi. Hastaların 54’ü (%78,3) erkek ve 15’i (%21,7) kadın idi. Kronik hepatit B virüs (HBV) enfeksiyonu nedeniyle karaciğer biyopsi yapılan hastaların seroloji, moleküler analiz, biyokimyasal parametreler ve patoloji sonuçları retrospektif olarak değerlendirildi. ALBI, APRI ve FIB-4 skorları hesaplandı. Fibrozis evresi F≥2 ve F≥4'ü tahmin etmek için ALBI, APRI ve FIB-4 skorları, alıcı işlem karakteristiği (receiver operator characteristic, ROC) eğrisi analizi kullanılarak araştırıldı.
Bulgular: ALBI, APRI ve FIB-4 skorları için F≥2 tahmininde %95 güven aralığı (GA) ile ROC eğrisi altında kalan alan, sırasıyla, 0,613 (%95 GA: 0,463-0,762; p=0,160), 0,658 (%95 GA: 0,513-0,803; p=0.040) ve 0,731(%95 GA: 0,570-0,891; p=0,004) iken F≥4 tahmininde ise sırasıyla, 0,758 (%95 GA: 0,544-0,971; p=0,090), 0,604 (%95 GA: 0,451-0,757; p=0,490) ve 0,923 (%95 GA: 0,856-0,990; p=0,005) idi. ALBI skoru için duyarlılık ve özgüllük değerleri F≥2 tahmininde -2.81 kesim değeri için sırasıyla, %61,1 ve %64,7 iken F≥4 tahmininde -2.78 kesim değeri için sırasıyla, %75,0 ve %70,8 idi.
Sonuç: Kronik HBV’li hastalarda F≥2’yi belirlemek için ALBI skoru kullanılabilir. Ancak, bu yaklaşımın F≥4'ü saptamak için diğer invaziv olmayan yöntemlerden üstün olup olmadığı henüz açık değildir.

Keywords

Hepatit B, kronik, biyopsi, fibrozis

Relationship between Histopathological Stages of Liver and Albumin-Bilirubin Score in Hepatitis B Infection

Abstract

Aim: In this study, sensitivity and specificity of the albumin-bilirubin (ALBI) score were investigated to detect significant liver fibrosis, and these findings were then compared to fibrosis-4 (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) scores.
Material and Methods: A total of 69 patients were included in the study. Of these patients, 54 (78.3%) were male and 15 (21.7%) were female. Serology, molecular analysis, biochemical parameters, and pathology results of the patients who underwent a liver biopsy due to a chronic hepatitis B virus (HBV) infection, were retrospectively evaluated. ALBI, APRI, and FIB-4 scores were calculated. To predict the fibrosis stage, F≥2 and F≥4, ALBI, APRI, and FIB-4 scores were investigated using the receiver operator characteristic (ROC) curve analysis.
Results: The area under the ROC curve with 95% confidence interval (CI) for the ALBI, APRI, and FIB-4 scores were 0.613 (95% CI: 0.463-0.762, p=0.160), 0.658 (95% CI: 0.513-0.803, p=0.040), and 0.731 (95% CI: 0.570-0.891, p=0.004), respectively, to predict the F≥2, and 0.758 (95% CI: 0.544-0.971, p=0.090), 0.604 (95% CI:0.451-0.757, p=0.490), and 0.923 (95% CI: 0.856-0.990, p=0.005), respectively, in prediction of F≥4. The sensitivity and specificity rates of the ALBI score were 61.1% and 64.7%, respectively, for the cut-off value of -2.81 in predicting F≥2, and 75.0% and 70.8% for the cut-off value of -2.78 in predicting F≥4.
Conclusion: ALBI scores can be used to detect F≥2 in patients with chronic HBV. However, it is not yet clear whether this approach is superior to other non-invasive methods for detecting F≥4.

Keywords

Hepatitis B, chronic, biopsy, fibrosis

References

• Xia Y, Liang TJ. Development of direct-acting antiviral and host-targeting agents for treatment of hepatitis B virus infection. Gastroenterology. 2019;156(2):311-24.
• who.int [Internet]. Hepatitis B. [Cited: 2020 January 29]. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b
• Hyun Kim B, Ray Kim W. Epidemiology of hepatitis B virus infection in the United States. Clin Liver Dis (Hoboken). 2018;12(1):1-4.
• Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015;386(10003):1546-55.
• Özkan H. Epidemiology of chronic hepatitis B in Turkey. Euroasian J Hepatogastroenterol. 2018;8(1):73-4.
• Koc ÖM, Hens N, Bielen R, Van Damme P, Robaeys G. Hepatitis B virus prevalence and risk factors in hard-to-reach Turkish population living in Belgium: A protocol for screening. Medicine (Baltimore). 2019;98(18):e15412.
• Sarin SK, Kumar M, Lau GK, Abbas Z, Chan HL, Chen CJ, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int. 2016;10(1):1-98.
• Fattovich G, Bortolotti F, Donato F. Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors. J Hepatol. 2008;48(2):335-52.
• Poh Z, Goh BB, Chang PE, Tan CK. Rates of cirrhosis and hepatocellular carcinoma in chronic hepatitis B and the role of surveillance: a 10-year follow-up of 673 patients. Eur J Gastroenterol Hepatol. 2015;27(6):638-43.
• Cornberg M, Protzer U, Petersen J, Wedemeyer H, Berg T, Jilg W, et al. [Prophylaxis, diagnosis and therapy of hepatitis B virus infection - the German guideline]. Z Gastroenterol. 2011;49(7):871-930. German.
• Parikh P, Ryan JD, Tsochatzis EA. Fibrosis assessment in patients with chronic hepatitis B virus (HBV) infection. Ann Transl Med. 2017;5(3):40.
• Ma J, Jiang Y, Gong G. Evaluation of seven non-invasive models in staging liver fibrosis in patients with chronic hepatitis B virus infection. Eur J Gastroenterol Hepatol. 2013;25(4):428-34.
• Colloredo G, Guido M, Sonzogni A, Leandro G. Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. J Hepatol. 2003;39(2):239-44.
• Usluer G, Erben N, Aykin N, Dagli O, Aydogdu O, Barut S, et al. Comparison of non-invasive fibrosis markers and classical liver biopsy in chronic hepatitis C. Eur J Clin Microbiol Infect Dis. 2012;31(8):1873-8.
• López Panqueva RDP. Useful algorithms for histopathological diagnosis of liver disease based on patterns of liver damage, Rev Col Gastroenterol. 2016;31(4):443-57.
• Fujita K, Oura K, Yoneyama H, Shi T, Takuma K, Nakahara M, et al. Albumin-bilirubin score indicates liver fibrosis staging and prognosis in patients with chronic hepatitis C. Hepatol Res. 2019;49(7):731-42.
• Jin W, Lin Z, Xin Y, Jiang X, Dong Q, Xuan S. Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis B-related fibrosis: a leading meta-analysis. BMC Gastroenterol. 2012;12:14.
• Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple non-invasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38(2):518-26.
• McPherson S, Stewart SF, Henderson E, Burt AD, Day CP. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut. 2010;59(9):1265-9.
• Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al. Development of a simple non-invasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43(6):1317-25.
• Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 2015;33(6):550-8.
• Chan AW, Chan RC, Wong GL, Wong VW, Choi PC, Chan HL, et al. New simple prognostic score for primary biliary cirrhosis: Albumin-bilirubin score. J Gastroenterol Hepatol. 2015;30(9):1391-6.
• Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-VenierV, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology. 2007;46(1):32-6.
• Goodman ZD. Grading and staging systems for inflammation and fibrosis in chronic liver diseases. J Hepatol. 2007;47(4):598-607.
• Stauber RE, Lackner C. Non-invasive diagnosis of hepatic fibrosis in chronic hepatitis C. World J Gastroenterol. 2007;13(32):4287-94.
• Sebastiani G, Alberti A. Non invasive fibrosis biomarkers reduce but not substitute the need for liver biopsy. World J Gastroenterol. 2006;12(23):3682-94.
• Bulut C, Yetkin MA, Çaydere M, Erdinç FŞ, Kınıklı S, Tülek N, et al. [Assessment of noninvasive methods for prediction of fibrosis in patients with chronic hepatitis B]. Flora 2007;12(3):128-34. Turkish.
• Zhou K, Lu LG. Assessment of fibrosis in chronic liver diseases. J Dig Dis. 2009;10(1):7-14.
• Loaeza-del-Castillo A, Paz-Pineda F, Oviedo-Cárdenas E, Sánchez-Avila F, Vargas-Vorácková F. AST to platelet ratio index (APRI) for the non-invasive evaluation of liver fibrosis. Ann Hepatol. 2008;7(4):350-7.
• Saad EA. Non-invasive assessment of liver fibrosis using serum markers. J Pharm Chem Biol Sci. 2014;2(2):59-76.
• Zhang Z, Wang G, Kang K, Wu G, Wang P. Diagnostic accuracy and clinical utility of a new non-invasive index for hepatic steatosis in patients with hepatitis B virus infection. Sci Rep. 2016;6:32875.
• Dong XQ, Wu Z, Li J, Wang GQ, Zhao H; China HepB-Related Fibrosis Assessment Research Group. Declining in liver stiffness cannot indicate fibrosis regression in patients with chronic hepatitis B: A 78-week prospective study. J Gastroenterol Hepatol. 2019;34(4):755-63.
• Serag WM, Mohamed MM, Elsayed BE, Abd-Elhamed SM. Determination of liver fibrosis stages in Egyptian chronic hepatitis B patients by a non-invasive tool. Turk J Med Sci. 2019;49(4):1145-50.
• Liu DP, Lu W, Zhang ZQ, Wang YB, Ding RR, Zhou XL, et al. Comparative evaluation of GPR versus APRI and FIB-4 in predicting different levels of liver fibrosis of chronic hepatitis B. J Viral Hepat. 2018;25(5):581-9.
• Chen B, Lin S. Albumin-bilirubin (ALBI) score at admission predicts possible outcomes in patients with acute-on-chronic liver failure. Medicine (Baltimore). 2017;96(24):e7142.
• Alsebaey A, Badr R, Abdelsameea E, Amer MO, Eljaky MA, El-Azab G, et al. King’s fibrosis, fibrosis index, GPR, and ALBI score are useful models for liver fibrosis in chronic hepatitis B patients pre- and post-treatment. Hepat Mon. 2019;19(11):e96081.