Hello everyone, we begin the month of July with information about noninvasive tests used to measure severity of liver fibrosis in chronic hepatitis C infection.
In the July issue of Alimentary Pharmacology & Therapeutics, researchers found a combination of blood tests which focus on fibrosis and cirrhosis; are more accurate than liver biopsy for determining liver prognosis in hepatitis C. A quick summary of the study published over at Gastrohep.com, is provided further down the page.
Transient Elastography
FibroScan® was FDA approved in April 2013, and is one noninvasive test most of us are familiar with. FibroScan®, sometimes called transient elastometry (TE), is a noninvasive test designed to measure liver fibrosis, (arguably) comparable to a liver biopsy, particularly in the higher end of the Metavir scale (Stages 3 and 4). The procedure is comparable to ultrasound tests we have had to diagnose other internal diseases. Henry Ford Hospital, in Detroit, offers a closer look;
The skin in the area of the liver is first coated with a water-based gel. The doctor then passes an ultrasound sensor over the area to take 10 consecutive readings. The sensor produces vibrations that create a low-frequency seismic wave sent between the ribs and into the liver. The speed of the wave as it passes through the liver is used to determine the hardness or stiffness of the organ – the faster the wave, the harder the tissue.
For additional information head over to NATAP for a clinical assessment of Fibroscan, including patients with both NAFLD and HCV, hepatitis C alone, hepatitis B and other liver disease. Another great article can be found in the June Issue of HCV Next @ Healio; The Next Wave: Noninvasive Alternatives to Assess Fibrosis. In addition, HCV Advocate recently published an article by Maurizio Bonacini, MD; Use of Fibroscan® in Clinical Practice, and finally, check out; FibroScan® Scoring Card - Understanding The Results.
From Gastrohep.com:
Combination blood tests improve the assessment of liver-prognosis in Hep C
A study in the latest Alimentary Pharmacology & Therapeutics finds that the combination of blood tests for significant fibrosis and cirrhosis improves the assessment of liver-prognosis in chronic hepatitis C.
Recent longitudinal studies have emphasised the prognostic value of noninvasive tests of liver fibrosis and cross-sectional studies have shown their combination significantly improves diagnostic accuracy.
Dr Boursier and colleagues compared the prognostic accuracy of 6 blood fibrosis tests and liver biopsy, and evaluated if test combination improves the liver-prognosis assessment in chronic hepatitis C.
A total of 373 patients with compensated chronic hepatitis C, liver biopsy (Metavir F) and blood tests targeting fibrosis or cirrhosis were included.
Significant liver-related events and liver-related deaths were recorded during follow-up.
During the median follow-up of 9.5 years, the team found that 47 patients had a liver-related events, and 23 patients died from liver-related causes.
For the prediction of first liver-related events, most blood tests allowed higher prognostication than liver biopsy with a significant increase for FIB.
The team found that FibroMeter, CirrhoMeter and sustained viral response were independent predictors of first liver-related events.
CirrhoMeter was the only independent predictor of liver-related death.
The team observed that the combination of FibroMeter and CirrhoMeter classifications into a new FM/CM classification improved the liver-prognosis assessment compared to liver biopsy staging or single tests by identifying five subgroups of patients with significantly different prognoses.
Boursier's team concluded, "Some blood fibrosis tests are more accurate than liver biopsy for determining liver prognosis in chronic hepatitis C."
"A new combination of 2 complementary blood tests, one targeted for fibrosis and the other for cirrhosis, optimises assessment of liver-prognosis."
Aliment Pharmacol Ther 2014: 40(2): 178–18801 July 2014
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