Chronic Hepatitis C, biopsy is the gold standard for assessment of liver fibrosis.
Non-invasive markers have been proposed but their use is limited by diagnostic accuracy.
Dr Giada Sebastiania and colleagues from Italy assessed the diagnostic performance of non-invasive markers of liver fibrosis.
The investigative team combined the non-invasive markers in sequential algorithms.
The team evaluated 190 patients with chronic Hepatitis C.
Aspartate aminotransferase to platelets ratio, Forns' index, and Fibrotest at the time of liver biopsy were measured.
A stepwise combination algorithm was developed and validated prospectively in 100 additional patients.
The team developed 3 algorithms.
|The need for liver biopsy is reduced by 50 to 70%|
|Journal of Hepatology|
The first algorithm included significant fibrosis identified with high diagnostic performance using aspartate aminotransferase to platelets ratio as a screening test.
This was followed by a fibrotest in aminotransferase to platelets ratio non-classified cases.
The first algorithm was also identified by restricting liver biopsy to patients classified F0 to F1 by non-invasive tests.
The second slightly modified algorithm had a similar performance when applied to Hepatitis C carriers with normal alanine aminotransferase.
In the third algorithm, cirrhosis was identified using a dedicated algorithm with a different cut-off, reducing the liver biopsies needed by 60 to 70%.
Dr Sebastiania's team concluded, “Stepwise combination of non-invasive markers of liver fibrosis improves the diagnostic performance in chronic Hepatitis C. “
“Need for liver biopsy is reduced by 50 to 70% but cannot be completely avoided.”