Fibrosis is a hallmark of hepatic cirrhosis. The worsening of fibrosis is probably the best surrogate marker for progression of chronic liver disease.
In a study published in the January issue of Gastroenterology, researchers evaluated 123 patients with chronic hepatitis C (CHC).
The research team used liver histology to assess the rate and predictors of progression of fibrosis.
Patients in the study had undergone 2 liver biopsies 4 to 212 months apart without intervening treatment.
The team graded the liver histology using the histology activity index.
|39% of patients showed progression in fibrosis scores.|
They also staged the fibrosis using a scoring system of 0 (no fibrosis) to 6 (cirrhosis).
The researchers found that of the 123 patients, 39% showed progression in fibrosis scores, 37% showed no change, and 24% showed improvement.
Of those with worsening fibrosis, 75% had a 1-point increase and 25% a 2-point or greater increase in scores, and 9% showed progression to cirrhosis.
The team determined that the overall rate of progression was 0.12 fibrosis units per year.
The rate of fibrosis progression was variable.
Progression was higher among older patients, those with higher serum alanine and aspartate aminotransferase levels, and those with the most extensive periportal necrosis on initial liver biopsy.
Dr Marc Ghany's team concluded, "The best predictors of fibrosis progression in chronic hepatitis C are the extent of serum aminotransferase elevations and the degree of hepatocellular necrosis and inflammation on liver biopsy".
"These findings support the recommendation that patients with normal aminotransferase levels and mild liver histology can safely defer treatment".