Assessment of liver fibrosis in Egyptian chronic hepatitis B patients

Tag-Adeen, Mohammed; Omar, Maha Z; Abdel-Salam, Fatma; Hasaneen, Ali; Mohamed, Mohamed Ahmed; Elfeky, Hala M.; Said, Ebada; Abdulaziz, Badawy A.; A, Osman; Ahmed, Emad A.; Osman, Ghada S.; Abdul-Samie, Taghreed

doi:10.1097/md.0000000000009781

Cited by 13 publications

(20 citation statements)

References 32 publications

(32 reference statements)

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“…The correlation between enzymatic liver function measured by LiMAx ® and different stages of fibrosis was superior (Spearman's r = -0.68) when compared to validated [5,18,19,21,22,25,26,[44][45][46][47][48][49][50][51]. Transient elastography (TE) is probably the most validated method worldwide in the noninvasive assessment of liver fibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Different diagnostic tools have been developed and partly implemented in clinical practice and international guidelines [14][15][16]. Serum biomarkers such as aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), AST-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) score based on readily available laboratory parameters have been extensively examined to stage liver fibrosis [17][18][19][20][21]. In addition, liver stiffness determined by transient elastography (TE), a technique based on the measurement of the velocity of a shear wave that is induced to the liver by a mechanical impulse, is probably the most validated noninvasive method to assess the stage of liver fibrosis with reliable diagnostic accuracy for different etiologies of CLD [22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

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Liver Maximum Capacity: A Novel Test to Accurately Diagnose Different Stages of Liver Fibrosis

et al. 2018

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Aim: To assess the diagnostic accuracy of liver maximum capacity (LiMAx®) test compared to transient elastography (TE) and serum biomarkers for the noninvasive detection of different stages of liver fibrosis and cirrhosis. Patients and Methods: We retrospectively correlated LiMAx®, TE, aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), AST-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) score with histological specimens in 102 patients with chronic liver disease (CLD) who underwent liver biopsy (either percutaneously or via mini-laparoscopy) at the University Clinic of Essen between 10/2016 and 12/2017. Results: Median LiMAx® values showed a tendency to decrease in accordance with increasing histological degree of fibrosis based on the Desmet scoring system (F0: 446.5 [381.0–592.5] µg/h/kg, F1: 405.0 [343.0–547.0] µg/h/kg, F2: 337.0 [250.0–394.0] µg/h/kg, F3: 281.0 [262.0–364.0] µg/h/kg, and F4: 181.5 [130.0–256.5] µg/h/kg. Furthermore, LiMAx® was superior to TE, FIB-4, AAR, and APRI in detecting different stages of fibrosis, while Spearman’s rank correlation test showed a statistically significant association of –0.68, 0.62, 0.61, 0.46, and 0.42, respectively. However, the combination of TE and LiMAx® had the highest diagnostic accuracy in detecting liver cirrhosis (sensitivity 88.9%, specificity 84.6%, Youden index 0.735). Conclusion: Enzymatic liver function measured by LiMAx® showed strong correlation with histology in patients with CLD irrespective of its underlying etiology and was superior to TE and serum biomarkers, possibly making it useful as a novel and noninvasive tool for the determination of hepatic disease severity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Liver Maximum Capacity: A Novel Test to Accurately Diagnose Different Stages of Liver Fibrosis

et al. 2018

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“…However, diagnostic accuracy is not well established in sSA and can be influenced by the population being assessed and the nature of underlying liver disease. [10][11][12][13][14][15] GPR has recently been reported as an independent predictor of significant fibrosis in naive Gambian patients with chronic hepatitis B (CHB) infection, 13 while the usefulness of cut-off values for APRI scores in CHB has been questioned. 16 However, further studies are needed to determine the specificity and sensitivity of different scores in different settings.…”

Section: Introductionmentioning

confidence: 99%

Liver function tests and fibrosis scores in a rural population in Africa: a cross-sectional study to estimate the burden of disease and associated risk factors

et al. 2020

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ObjectivesLiver disease is a major cause of morbidity and mortality in sub-Saharan Africa, but its prevalence, distribution and aetiology have not been well characterised. We therefore set out to examine liver function tests (LFTs) and liver fibrosis scores in a rural African population.DesignWe undertook a cross-sectional survey of LFTs. We classified abnormal LFTs based on reference ranges set in America and in Africa. We derived fibrosis scores (aspartate aminotransferase (AST) to Platelet Ratio Index (APRI), fibrosis-4, gamma-glutamyl transferase (GGT) to platelet ratio (GPR), red cell distribution width to platelet ratio and S-index). We collected information about alcohol intake, and infection with HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV).SettingWe studied a population cohort in South-Western Uganda.ParticipantsData were available for 8099 adults (median age 30 years; 56% female).ResultsThe prevalence of HBV, HCV and HIV infection was 3%, 0.2% and 8%, respectively. The prevalence of abnormal LFTs was higher based on the American reference range compared with the African reference range (eg, for AST 13% vs 3%, respectively). Elevated AST/ALT ratio was significantly associated with self-reported alcohol consumption (p<0.001), and the overall prevalence of AST/ALT ratio >2 was 11% (suggesting alcoholic hepatitis). The highest prevalence of fibrosis was predicted by the GPR score, with 24% of the population falling above the threshold for fibrosis. There was an association between the presence of HIV or HBV and raised GPR (p=0.005) and S-index (p<0.001). By multivariate analysis, elevated LFTs and fibrosis scores were most consistently associated with older age, male sex, being under-weight, HIV or HBV infection and alcohol consumption.ConclusionsFurther work is required to determine normal reference ranges for LFTs in this setting, to evaluate the specificity and sensitivity of fibrosis scores and to determine the aetiology of liver disease.

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“…However, there is evidence showing that APRI is more accurate in assessing liver fibrosis among individuals with chronic HCV compared to HBV infection (11). GPR and S-Index have been validated in small studies in sSA, and have been associated with improved classification of liver fibrosis in chronic HBV infection when compared to APRI and FIB-4 (12)(13)(14). It is apparent that either larger studies, or indeed a meta-analysis, are required to further assess the accuracy of these tests in different populations.…”

Section: Discussionmentioning

confidence: 99%

“…However diagnostic accuracy is not well established in sSA and can be influenced by the population being assessed and the nature of underlying liver disease (9)(10)(11)(12)(13)(14). GPR has recently been reported as an independent predictor of significant fibrosis in treatment naïve Gambian patients with chronic hepatitis B (CHB) infection (12).…”

Section: Introductionmentioning

confidence: 99%

Liver function tests and fibrosis scores in a rural population in Africa: estimation of the burden of disease and associated risk factors

O’Hara

Mokaya

Hau

et al. 2019

Preprint

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Introduction: Liver disease is a major cause of morbidity and mortality in sub-Saharan Africa. However, its prevalence, distribution and aetiology have not been well characterised. We examined liver function tests (LFTs) and calculated liver fibrosis scores in a rural population in Uganda. Methodology: A cross-sectional survey of LFTs was undertaken in 2011 in a rural population cohort in South-Western Uganda. We classified abnormal LFTs based on reference ranges set in America and in Africa. We derived fibrosis scores (AST to Platelet Ratio Index, fibrosis-4, GGT to platelet ratio, red cell distribution width to platelet ratio, and S-index) to evaluate the potential prevalence of liver disease. We collected information about alcohol intake, and infection with HIV, HBV and HCV, to determine the contribution made by these factors to liver inflammation or fibrosis. Results: Data were available for 8,099 participants (median age 30 years; 56% female). The prevalence of HBV, HCV and HIV infection were 3%, 0.2% and 8%, respectively. The prevalence of abnormal LFTs was higher based on the American reference range compared to the African reference range (e.g. for AST 13% vs 3%, respectively). The prevalence of AST/ALT ratio >2 was 11%, suggestive of alcoholic hepatitis. The highest prevalence of fibrosis was suggested by the GPR score, with 24% of the population falling above the threshold for fibrosis. By multivariate analysis, elevated LFTs and fibrosis scores were most consistently associated with older age, male sex, being under-weight, infection with HIV or HBV, and alcohol consumption. Based on population attributable risk, the highest proportion of elevated fibrosis scores was associated with alcohol use (e.g. 64% of elevated S-index scores). Conclusion: Further work is required to determine normal reference ranges for LFTs in this setting, to evaluate the specificity and sensitivity of fibrosis scores, and to determine aetiology of liver disease.

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Assessment of liver fibrosis in Egyptian chronic hepatitis B patients

Cited by 13 publications

References 32 publications

Liver Maximum Capacity: A Novel Test to Accurately Diagnose Different Stages of Liver Fibrosis

Liver Maximum Capacity: A Novel Test to Accurately Diagnose Different Stages of Liver Fibrosis

Liver function tests and fibrosis scores in a rural population in Africa: a cross-sectional study to estimate the burden of disease and associated risk factors

Liver function tests and fibrosis scores in a rural population in Africa: estimation of the burden of disease and associated risk factors

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