HEPATIC ELASTOGRAPHY AND FIB-4 SCORE VERSUS LIVER BIOPSY FOR ASSESSMENT OF LIVER FIBROSIS IN CHRONIC HCV PATIENTS

Abstract

ABSTRACT
Background: Chronic HCV infection is a major global health problem. Liver biopsy still the gold standard tool
for assessment of hepatic fibrosis, however, real time hepatic elastography assessment and FIB-4 score
calculation may be valuable alternatives. Aim of the work: Clarifying whether, hepatic elastography assessment
and FIB4-score calculation are good and acceptable alternatives for Liver biopsy for assessment of liver fibrosis
in patients with chronic HCV infection. Patients and Methods: The study was carried out through seven
months duration on sixty-five HCV infected patients who were eligible for standard of care direct acting antiviral
medications. Routine laboratory workup, abdominal US, transient hepatic elastography assessment, FIB-4 score
calculation and liver biopsy were done for all participants. Results: ANOVA study of participant's age, Hb %,
platelets count, albumin, ALT and AST among fibrosis stages diagnosed by LB showed no significant
differences regarding participant's age and Hb%, while, a significant difference regarding serum albumin (p
=0.05) and highly significant difference were found regarding platelets count, serum ALT and AST (p=0.001,
<0.001and <0.001 respectively). Post hoc study of the previous parameters between different fibrosis stages
(Liver biopsy) showed no significant differences were found between F0 & F1, F0 & F2 and F1 & F2 regarding
all parameters. No significant differences regarding Hb% and age but, highly significant differences were found
between F0 &F3 as regard platelets count, albumin, ALT and AST. No significant differences regarding Hb%
and age but, a significant difference and highly significant differences were found between F1 &F3 regarding
serum albumin, platelets count, ALT and AST respectively. No significant differences regarding age and serum
albumin but, highly significant differences were found as regard platelets count, ALT and AST between F2 &F3.
Elastography readings agreed with liver biopsy in 4 out of 4 in F0, 26 out of 38 in F1, 9 out of 12 and 8 out of 11
in F3. Elastography readings in comparison to corresponding fibrosis stages readings by LB showed sensitivity
(76.7%), specificity (100%), PPV (100%), NPV (96.7%) and accuracy rate (96.9%) with highly significant
difference (p =0.001). While FIB-4 score readings in comparison to corresponding fibrosis stage readings by
liver biopsy showed sensitivity (35%), specificity (91.1%), PPV (63.6%), NPV (75 %) and accuracy rate
(73.8%) with highly significant difference (p =0.001). Conclusion: Hepatic elastography assessment and FIB-4
score calculation are rapid, accurate and sensitive tools for assessment of liver fibrosis in chronic HCV patients.
Key words: Hepatic elastography; FIB-4 score; Liver biopsy; Liver fibrosis; Chronic HCV