Clinical Utility of Simple Fibrosis Markers in Prediction of Oesophageal Varices in Chronic Hepatitis C Patients with Advanced Fibrosis
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- Category: Vol. 80, March 2012
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Clinical Utility of Simple Fibrosis Markers in Prediction of Oesophageal Varices in Chronic Hepatitis C Patients with Advanced Fibrosis,GHADA M. GALAL, ALI A. GHWEIL, EMAN M.S. MUHAMMAD and LAILA M. YOUSEF
Abstract
Background and Aims: Oesophageal varices (OV) are the most common complication of liver cirrhosis. However, no available data exist on the prevalence and the laboratory predictors of OV in chronic hepatitis C (CHC) Egyptian patients with bridging fibrosis or cirrhosis. Therefore, we aimed to investigate the frequency of OV in these patients and to assess whether simple non-invasive serum fibrosis markers help in screening endoscopy for detection of OV in these patients.
Patients and Methods: Two hundred CHC treatment naïve patients (116 stage 3: bridging fibrosis and 84 stage 4: cirrhosis) were enrolled in the study. All patients had liver biopsy examined by a single histopathologist using Desmet et al. staging and grading system. Non-invasive fibrosis markers (platelet count, AST/ALT ratio, APRI, Fib 4 index and BARD score) were calculated for all of them. All patients underwent screening upper gastrointestinal endoscopy for detection of OV.
Results: The overall frequency of OV was 100/200 (50%). Forty-two patients (36.2%) of stage 3 had OV. While, Fifty-eight (69%) of patients of stage 4 had OV. Patients with OV had significantly lower platelet count and albumin and higher AST, ALT, APRI. ROC analysis revealed an AUC of 0.351, 0.382, 0.624 for platelets, albumin and APRI respectively.
Conclusions: A high frequency of OV in CHC even before histological detection of cirrhosis indicates that liver biopsy may underestimate the actual prevalence of liver cirrhosis and portal hypertension in these patients. None of the tested serum fibrosis markers can reliably help in screening for diagnosis of OV in CHC patients with stage 3 or 4 fibrosis.