Non‐invasive fibrosis markers for assessment of liver fibrosis in chronic hepatitis delta

Abstract

Assessment of liver fibrosis by non‐invasive means is clinically important. Studies in chronic hepatitis delta (CHD) are scarce. We evaluated the performance of eight serum fibrosis markers [fibrosis‐4 score (FIB‐4), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), age‐platelet index (API), AST‐to platelet‐ratio‐index (APRI), Goteborg University Cirrhosis Index (GUCI), Lok index, cirrhosis discriminant score (CDS) and Hui score] in CHD and chronic hepatitis B (CHB). Liver stiffness was assessed by transient elastography (TE) in CHD. The ability of fibrosis markers to detect significant fibrosis and cirrhosis were evaluated in 202 CHB and 108 CHD patients using published and new cut‐offs through receiver operating characteristics (ROC) analysis. The latter was also applied to obtain cut‐offs for TE. APRI, Fib‐4, API and Hui score were assessed for significant fibrosis, and APRI, GUCI, Lok index, CDS and AAR for cirrhosis determination. Fibrosis markers displayed weak performance in CHB for significant fibrosis with area under ROC (AUROC) curves between 0.62 and 0.71. They did slightly better for CHD. TE displayed an AUROC of 0.92 and performed better than serum fibrosis markers (p < 0.05 for fibrosis markers). For cirrhosis determination, CDS and Lok Index displayed an AUROC of 088 and 0.89 in CHB and GUCI, Lok index and APRI displayed AUROCs around 0.90 in CHD. TE displayed the best AUROC (0.95). Hence TE is superior to serum fibrosis markers for diagnosing significant liver fibrosis and cirrhosis. GUCI, Lok index and APRI displayed a reasonable performance in CHD, which needs further confirmation.

Liver stiffness measurement as a noninvasive method for the diagnosis of liver cirrhosis in patients with chronic hepatitis D virus infection

“…14,23 Similar to our data, TE was superior to serological NITs for the detection of liver cirrhosis, but cut-offs for the detection of liver cirrhosis differ. In the study by Kalkan et al 23 a lower cut-off of 10 kPa was identified to distinguish between cirrhosis and no cirrhosis. This is in contrast to our data proposing a higher cut-off for the identification of liver cirrhosis.…”

“…TE in particular is used on a regular basis for initial staging of liver fibrosis and longitudinal monitoring of patients. For CHD, only two studies evaluated the diagnostic performance of TE 14,23 . Similar to our data, TE was superior to serological NITs for the detection of liver cirrhosis, but cut‐offs for the detection of liver cirrhosis differ.…”

“…Similar to our data, TE was superior to serological NITs for the detection of liver cirrhosis, but cut‐offs for the detection of liver cirrhosis differ. In the study by Kalkan et al 23 . a lower cut‐off of 10 kPa was identified to distinguish between cirrhosis and no cirrhosis.…”

Editorial: Liver elastography for chronic hepatitis D—the end of liver biopsy?

“…3 There are some discrepancies regarding the optimal cut-off value for LSM to rule out cirrhosis (Table 1). Kalkan et al 5 proposed that a cut-off >10 Kpa (AUC: 0.95) is most effective for excluding cirrhosis, based on a patient cohort where a significant proportion were receiving interferon, which may affect LSM results. Da et al 6 suggested a cut-off (>14 Kpa), more similar to that reported by Sandmann, but only half the patients underwent liver biopsy.…”

Treatment endpoints for chronic hepatitis D

“…37,46 Assessment of liver stiffness by transient elastography (TE) may provide information on the fibrosis stage. TE appears to be the best non-invasive method for diagnosing significant fibrosis and cirrhosis 76,77 and similar to hepatitis B and hepatitis C they are better in ruling out cirrhosis than ruling in cirrhosis. However, suggested cut-offs for ruling in and ruling out cirrhosis have not been validated for CHD.…”