Assessment of liver fibrosis before and after antiviral therapy by different serum marker panels in patients with chronic hepatitis C

Stella M Martinez (1) , Guillermo Fernández-Varo (2) , Patricia González (1) , Ellen Sampson (3) , Miguel Bruguera (1) , Miguel Navasa (1) , Wladimiro Jiménez (2) , Josem Sanchez-Tapias (4, 1) , Xavier Forns (1)

1 Liver Unit
2 Biochemistry and Molecular Genetics Department
3 Siemens Healthcare Diagnostics
4 Hepatology

ABSTRACT Background/Aims: Liver biopsy is the reference standard to assess liver fibrosis in chronic hepatitis C (CHC). We validated and compared the diagnostic performance of noninvasive tests for prediction of liver fibrosis severity and assessed changes in extracellular matrix (ECM) markers after antiviral treatment. Methods: The performance of Forns'score, APRI, FIB-4 index, and ELF (Enhanced Liver Fibrosis) score was validated in 340 patients who underwent antiviral therapy. These scores were determined 24 weeks after treatment in 161 patients. Results: Forns' score, APRI, FIB-4 and ELF score showed comparable diagnostic accuracies for significant fibrosis (AUROC 0.83, 0.83, 0.85 and 0.81, respectively). To identify cirrhosis, FIB-4 index showed a significantly better performance over APRI and ELF score (AUROC 0.89 vs. 0.83 and 0.82, respectively). ELF score decreased significantly in patients with sustained virologic response (SVR) (p<0.0001) but remained unchanged in non-responders. Non-1 HCV genotype, baseline lower HCV RNA, glucose, hyaluronic acid and higher cholesterol levels were independently associated with SVR. Conclusions: Simple panel markers and ELF score are accurate at identifying significant fibrosis and cirrhosis in CHC. A decrease in ELF score after antiviral treatment reflects the impact of viral clearance in hepatic ECM and probably in the improvement of liver fibrosis.

Mots clés: Medicine

Stella M Martinez, Guillermo Fernández-Varo, Patricia González, Ellen Sampson, Miguel Bruguera, et al.. Assessment of liver fibrosis before and after antiviral therapy by different serum marker panels in patients with chronic hepatitis C. Alimentary Pharmacology and Therapeutics, 2010, 33 (1), pp.138. ⟨10.1111/j.1365-2036.2010.04500.x⟩. ⟨hal-00599491⟩