A suggested algorithm for using serum biomarkers for the diagnosis of liver fibrosis in chronic hepatitis C infection

Background and study aimsHepatitis C virus infection (HCV) is endemic in Egypt. Liver biopsy is the gold standard for diagnosis and staging of fibrosis in chronic hepatitis C patients. However, it is invasive, associated with sampling error and poses potential complications. A non-invasive alternative is needed.This assessed the accuracy of certain biochemical markers and ultrasonography in predicting the stage of fibrosis in chronic hepatitis C patients.Patients and methodsSixty five patients with chronic HCV were enrolled. Ultrasonographic examination, complete blood count and liver function tests were done. Serum levels of hyaluronic acid (HA) and YKL-40 (a 40-kDa glycoprotein produced by stellate cells) were determined. Liver biopsy was done. Fibrosis was correlated with biochemical markers and ultrasonographic findings.ResultsHistopathological examination showed that 39 patients (60%) had F1, nine (14%) had F2, 17 (26%) had F3 and none had F0 or F4 scores. A value of alanine aminotransferase (ALT) index < 0.38, HA < 9.7 ng ml−1 or portal vein (PV) cross-sectional area <25.8 mm2 excluded significant fibroses (⩾F2). A value of aspartate aminotransferase (AST) + ALT < 39.5 or ratio of AST index to the platelet count (APRI) < 0.235 or HA × 100 per platelet (Plt) < 9.534 excluded the presence of advanced fibrosis with 100% negative predictive value (NPV). Using these values, advanced fibrosis could be excluded in 72% of our patients. An APRI value of ⩾1.1 can diagnose advanced fibrosis with 100% positive predictive value (PPV) in 10% of our patients. Hence, only 18% of our patients in whom liver biopsy was recommended were not classified by these parameters. YKL-40 did not help in the diagnosis of advanced fibrosis.ConclusionApplying a simple algorithm based on ALT, AST, platelet count, PV cross-sectional area, in addition to HA level may eliminate the need for liver biopsies in more than 80% of chronic HCV patients.