Noninvasive markers for staging fibrosis in chronic delta hepatitis

Abstract

Background Serum fibrosis markers are useful in staging chronic hepatitis B (HBV) and C (HCV) but have not been evaluated in chronic hepatitis D (HDV). Aims We evaluated the utility of serum fibrosis markers (fibrosis-4 score [FIB-4], AST to ALT ratio [AAR], age-platelet index [API], AST-to-platelet-ratio-index [APRI] and Hui score) in HDV infection. Methods Clinical and histologic laboratory data from HBV, HCV and HDV patients were evaluated and serum fibrosis markers were calculated. The ability of fibrosis markers to detect advanced fibrosis (Ishak ≥4) and cirrhosis (Ishak =6) were evaluated and compared between viral infections. Results 1003 subjects (HCV=701, HBV=240 and HDV=62) with mean age of 46 ±11 and 66% male were evaluated. HDV subjects had higher ALT and AST than HCV and lower platelets than both HBV and HCV. Histologically, HDV had the greatest percentage of Ishak≥4 and necroinflammation. FIB-4 performed best in detecting advanced fibrosis and cirrhosis in all viral cohorts. In HDV, area under the receiver operator curve (AUROC) 95% confidence intervals for detecting advanced fibrosis were: FIB-4=0.70 (0.55–0.84), API=0.69 (0.55–0.82), APRI=0.68 (0.54–0.82), Hui score=0.63 (0.49–0.78), AAR=0.63 (0.48–0.77). The AUROC for detecting cirrhosis in HDV were: FIB-4=0.83(0.69–0.97), API=0.80(0.66–0.95), APRI=0.75(0.61–0.89), Hui score=0.70(0.49–0.91) and AAR=0.70(0.48–0.93). Adjustment of published cut-offs led to marginal improvements in FIB4 for advanced fibrosis and of APRI for cirrhosis in HDV. Conclusions Serum fibrosis markers have lower performance accuracy in chronic HDV infected patients compared to HBV and HCV patients. Other noninvasive fibrosis markers should be explored to assist in the management of these patients.

Letter: changes in FIB‐4 cut‐off points for viral hepatitis – authors’ reply

“…We are greatly appreciative of the interest in our recent manuscript[1] by Dr. Kayadibi [2]and value the opportunity to discuss and clarify his concerns.…”

“… Conflicts of interest: None of the authors has financial interests or conflicts of interest related to this research. The authors’ declarations of personal and financial interests are unchanged from those in the original article[1]. …”

“…The authors’ declarations of personal and financial interests are unchanged from those in the original article[1]. …”

Letter: need to re-evaluate non-invasive markers for staging fibrosis in chronic delta hepatitis - authors’ reply

“…We are greatly appreciative of the interest in our recent manuscript(1) by Wu and colleagues(2) and are appreciative of the opportunity clarify their concerns.…”

“… The authors' declarations of personal and financial interests are unchanged from those in the original article(1). …”