Doppler ultrasonography combined with transient elastography improves the non-invasive assessment of fibrosis in patients with chronic liver diseases

Aims: Accurate clinical assessment of liver fibrosis is essential and the aim of our study was to compare and combine hemodynamic Doppler ultrasonography, liver stiffness by transient elastography, and non-invasive serum biomarkers with the degree of fibrosis confirmed by liver biopsy, and thereby to determine the value of combining non-invasive method in the prediction significant liver fibrosis. Material and methods: We included 102 patients with chronic liver disease of various etiology. Each patient was evaluated using Doppler ultrasonography measurements of the velocity and flow pattern at portal trunk, hepatic and splenic artery, serum fibrosis biomarkers, and transient elastography. These parameters were then input into a multilayer perceptron artificial neural network with two hidden layers, and used to create models for predicting significant fibrosis. Results: According to METAVIR score, clinically significant fibrosis (≥F2) was detected in 57.8% of patients. A model based only on Doppler parameters (hepatic artery diameter, hepatic artery systolic and diastolic velocity, splenic artery systolic velocity and splenic artery Resistance Index), predicted significant liver fibrosis with a sensitivity and specificity of75.0% and 60.0%. The addition of unrelated non-invasive tests improved the diagnostic accuracy of Doppler examination. The best model for prediction of significant fibrosis was obtained by combining Doppler parameters, non-invasive markers (APRI, ASPRI, and FIB-4) and transient elastography, with a sensitivity and specificity of 88.9% and 100%. Conclusion: Doppler parameters alone predict the presence of ≥F2 fibrosis with fair accuracy. Better prediction rates are achieved by combining Doppler variables with non-invasive markers and liver stiffness by transient elastography.

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Liver Fibrosis Assessment in a Cohort of Greek HIV Mono-Infected Patients by Non-Invasive Biomarkers

Current HIV Research ◽

10.2174/1570162x17666190809153245 ◽

2019 ◽

Vol 17 (3) ◽

pp. 173-182

Author(s):

Theodoros Androutsakos ◽

Maria Schina ◽

Abraham Pouliakis ◽

Athanasios Kontos ◽

Nikolaos Sipsas ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Sensitivity And Specificity ◽

Transient Elastography ◽

Standard Procedure ◽

Liver Stiffness ◽

Alcoholic Fatty Liver ◽

Non Invasive ◽

Metavir Score ◽

Significant Liver Fibrosis

Background: Non-alcoholic Fatty Liver Disease (NAFLD) is common in HIV-infected individuals. Liver biopsy remains the gold-standard procedure for the diagnosis of liver fibrosis, but both Transient Elastography (TE) and Non-invasive Biomarkers (NIBMs) have emerged as alternatives. Objectives: Our study’s aim was to validate commonly used NIBMs for the assessment of liver fibrosis in a cohort of Greek HIV-mono-infected patients. Methods: Inclusion criteria were confirmed HIV-infection and age>18 years and exclusion criteria HBV or HCV seropositivity, liver disease other than NAFLD, alcohol abuse, ascites, transaminases levels>4xULN(upper limit of normal) and Body-Mass index(BMI)>40. Liver stiffness (LS) measurement with TE and thorough laboratory work up and medical history were acquired at study entry. FIB-4, APRI, NFS, BARD, Forns and Lok scores were calculated for each patient. Results: A total of 157 patients were eligible for this study. Significant liver fibrosis, compatible with Metavir score of F3-F4, was found in only 11(7%) patients. These findings were in accordance with those of the NIBMs; the BARD score constituting the only exception, allocating 102(65%) patients as having significant liver fibrosis. In order to obtain a balance between sensitivity and specificity new cut-offs for each NIBM were calculated; FIB-4 score yielded the best results, since by changing the cut-off to 1.49 a sensitivity and specificity balanced for both close to 85% was achieved. Conclusions: Our findings suggest that NIBMs can be used for the evaluation of liver fibrosis in HIV mono-infected patients. New cut-offs for NIBMs should probably be calculated, to help distinguishing patients with significant from those with mild/no fibrosis.

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Combined Serum Golgi Membrane Glycoprotein 73 Improves the Accuracy of Transient Elastography for Significant Fibrosis Detection in Patients with Chronic HBV Infections

Hepatitis Monthly ◽

10.5812/hepatmon.102039 ◽

2021 ◽

Vol 21 (2) ◽

Author(s):

Qiaoxia Zhou ◽

Libo Yan ◽

Lingyao Du ◽

Xiaoqiong Tang ◽

Hong Tang

Keyword(s):

Liver Fibrosis ◽

Sensitivity And Specificity ◽

Transient Elastography ◽

Liver Stiffness ◽

Area Under The Curve ◽

Membrane Glycoprotein ◽

Golgi Membrane ◽

Significant Fibrosis ◽

Potential Biomarker ◽

Significant Liver Fibrosis

Background: Golgi membrane glycoprotein 73 (GP73) serum level is a potential biomarker for diagnosing significant fibrosis and cirrhosis in chronic liver diseases. Objectives: The current study aimed to evaluate the accuracy of GP73 serum levels as a biomarker in the diagnosis of significant liver fibrosis in patients with hepatitis B virus (HBV). A new promising algorithm was developed by combining LSM and GP73 to predict significant liver fibrosis. Methods: Information on the following parameters were obtained from 165 patients with HBV: liver stiffness measurement (LSM), serum GP73 level, and some other fibrosis criteria approved for clinical practice. The area under the curve (AUC) and sensitivity and specificity of GP73 were compared with LSM, aminotransferase-to-platelet ratio index (APRI), and 4-factor based fibrosis index (FIB-4) for diagnosing significant fibrosis. Results: Compared to the non-significant liver fibrosis patients, the HBV infected patients with significant fibrosis showed a higher level of serum GP73 [64.05 (24.41 - 144.39) versus 91.30 (31.81 - 200.05) ng/mL, P < 0.001]. Concerning significant fibrosis diagnosis, GP73 exhibited advantages regarding the AUC (0.702), sensitivity (69.3%), and specificity (66.0%). Besides, GP73 did not show any advantage over LSM and APRI, but it had a better performance than FIB-4 in significant fibrosis detection. For the newly developed algorithm combining GP73 with LSM, the AUC, sensitivity, and specificity were 0.848, 77.4%, and 83.5%, respectively; hence, it's superior to LSM (0.832, 72.6%, and 83.5%, respectively; P = 0.016) for diagnosing significant fibrosis. Conclusions: This study demonstrated that GP73 can be considered as a new effective biomarker for diagnosing liver fibrosis. The accuracy of significant fibrosis detection in patients with HBV infection can be improved by the new algorithm that contains GP73 and LSM.

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Non-invasive methods in the assessment of portal hypertension severity

Gastroenterologie a hepatologie ◽

10.48095/ccgh2021125 ◽

2021 ◽

Vol 75 (2) ◽

pp. 125-133

Author(s):

Soňa Franková ◽

Jan Šperl

Keyword(s):

Portal Hypertension ◽

Liver Fibrosis ◽

Shear Wave ◽

Transient Elastography ◽

Venous Pressure ◽

Liver Stiffness ◽

Invasive Technique ◽

Hepatic Veins ◽

Oesophageal Varices ◽

Non Invasive

Portal hypertension represents a wide spectrum of complications of chronic liver diseases and may present by ascites, oesophageal varices, splenomegaly, hypersplenism, hepatorenal and hepatopulmonary syndrome or portopulmonary hypertension. Portal hypertension and its severity predicts the patient‘s prognosis: as an invasive technique, the portosystemic gradient (HPVG – hepatic venous pressure gradient) measurement by hepatic veins catheterisation has remained the gold standard of its assessment. A reliable, non-invasive method to assess the severity of portal hypertension is of paramount importance; the patients with clinically significant portal hypertension have a high risk of variceal bleeding and higher mortality. Recently, non-invasive methods enabling the assessment of liver stiffness have been introduced into clinical practice in hepatology. Not only may these methods substitute for liver biopsy, but they may also be used to assess the degree of liver fibrosis and predict the severity of portal hypertension. Nowadays, we can use the quantitative elastography (transient elastography, point shear-wave elastrography, 2D-shear-wave elastography) or magnetic resonance imaging. We may also assess the severity of portal hypertension based on the non-invasive markers of liver fibrosis (i.e. ELF test) or estimate clinically signifi cant portal hypertension using composite scores (LSPS – liver spleen stiff ness score), based on liver stiffness value, spleen diameter and platelet count. Spleen stiffness measurement is a new method that needs further prospective studies. The review describes current possibilities of the non-invasive assessment of portal hypertension and its severity.

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The impact of direct-acting antivirals on liver fibrosis in Egyptian hepatitis C virus patients: a single center experience

QJM ◽

10.1093/qjmed/hcab107.007 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Nadia Abdelaaty Abdelkader ◽

Amira Mahmoud AlBalakosy ◽

Ahmed Fouad Helmy Sherief ◽

Mohamed Soliman Gado

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Liver Fibrosis ◽

Transient Elastography ◽

Liver Stiffness ◽

Treatment Unit ◽

Non Invasive ◽

One Year ◽

The Impact

Abstract Background Hepatitis C virus (HCV) infection affects approximately 170 million people worldwide, causing liver cirrhosis and hepatocellular carcinoma (HCC) and leading to liver transplantation and ultimately death. Accurate evaluation of liver fibrosis in patients with chronic liver diseases is crucial, as liver fibrosis is important in order to make therapeutic decisions, determine prognosis of liver disease and to follow-up disease progression. Multiple non-invasive methods have been used successfully in the prediction of fibrosis; however, early changes in noninvasive biomarkers of hepatic fibrosis under effective antiviral therapy are widely unknown. The aim of this study is to evaluate changes of transient elastography values as well as FIB-4 and AST to platelet ratio index (APRI) in patients treated with DAAs. Objectives The aim beyond this study is to evaluate the changes in liver stiffness in hepatitis C Egyptian patients before and at least one year after treatment with DAAs using transient elastography and non-invasive liver fibrosis indices as FIB-4 and APRI scores. Patients and methods The present study was conducted on 100 patients with chronic hepatitis C patients attended to Ain Shams University Hospitals, Viral hepatitis treatment unit between October 2017 and December 2018, who were followed-up during treatment and after treatment for at least one year (retrospective and prospective study). Total number of cases during the study period was 117 patients. 17 patients were excluded from the study due to missed follow-up. Eventually, 100 patients were enrolled in the study fulfilling the inclusion criteria. Results The mean age of our patients is 47.9 years with Male predominance (52 males and 48 females). There was a significant improvement of, platelets counts, ALT and AST levels, which in turn cause significant improvement in FIB-4 and APRI scores. There was a significant improvement of liver stiffness after end of treatment, regardless of the DAA regimen used, as evidenced by Fibroscan. Conclusion Fibrosis regression –assessed by non-invasive markers of fibrosis is achievable upon removal of the causative agent.

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Non Invasive Evaluation of Hepatic Iron Concentration By Fibroscan in Transfusion-Dependent Egyptian Patients with Chronic Hemolytic Anemia

Blood ◽

10.1182/blood-2018-99-118695 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 1061-1061

Author(s):

Amal El-Beshlawy ◽

Dalia Omran ◽

Hala Mohsen Abdullatif ◽

Niveen Salama ◽

Mohamed Ahmed Abdel Naeem ◽

...

Keyword(s):

Liver Fibrosis ◽

Iron Overload ◽

Sensitivity And Specificity ◽

Transient Elastography ◽

Iron Concentration ◽

Hepatic Iron ◽

Cell Disease ◽

Non Invasive ◽

Cutoff Values ◽

Chronic Hemolytic Anemia

Abstract Background: Transient elastography (Fibroscan®) is an ultrasound technique used to measure liver stiffness (LS), and thus assess for liver fibrosis, in patients with various chronic hepatic disorders. It can also be used to predict severity in multiple other diseases that might affect LS such as amyloidosis and possibly conditions associated with iron overload. Objectives: To assess the frequency of liver fibrosis in patients with chronic hemolytic anemia using Transient elastography (Fibroscan®), and to determine the reliability of this tool as a non-invasive method to predict hepatic iron content as compared to liver iron concentration (LIC) measured by magnetic resonance imaging (MRI). Patients and methods: Seventy-five transfusion dependent patients (50 β-thalassemia major;25 sickle cell disease) with a mean age of 13.4±5.2 years in addition to 75 -age and sex matched- healthy children were recruited. All subjects underwent assessment of LS in kilopascals (kPa), by Transient elastography measurement using FibroScan (Echosens, Paris, France І). Steady state serum ferritin (SF), and hepatitis B serologies (HBsAg and antiHB core antibodies) were assessed by enzyme linked immunoassay (ELISA). LIC values, within 6 months' duration, as identified by quantitative MRI of hepatic iron stores as a signal intensity ratio method based on T1 and T2* contrast imaging without gadolinium were retrieved. Informed consent was obtained from patients' legal guardians prior to enrollment in the study. Results: The median SF was 2280 ng/ml (84% had values exceeding 1000 ng/ml). The median LIC was 13.86 mg/g dw (78.7% patients showed LIC above 7 mg/g dw). The median cardiac T2* was 30.8 ms (3 patients had values below 20). Fifty-two (69.3%) patients were categorized as F0-1 and 21 (28%) were stage F2, 2 (1.3%) were stage F3, and 2 patients had severe fibrosis. The mean and median fibroscan (FS) values were 6.19 ±1.76 kPa and 5.9 kPa (range 3 to 14.1) respectively. Patients had significantly higher mean FS compared to control group (p ˂0.001). Patients with no or mild fibrosis (F0-1) had lower FS values (5.3kPa) compared to patients with fibrosis grades 2-4 (p ˂0.001). FS values were not affected by disease type (thalassemia or sickle cell disease), age (above 12 years), or HCV sero-positivity. FS values correlated with SF (r=0.410, p˂ 0.001). Simple regression analysis of the two variables suggested that changes in SF were associated with minimal but significant changes in FS values (p=0.04) with good agreement (kappa =0.324, p=0.003). LIC did not differ in relation to grade of fibrosis (p>0.05), did not correlate with FS values (r= 0.014, p=0.908), and no changes in FS were expected with LIC changes on regression analysis (p=0.466) with low agreement between LIC and FS at cutoff value 5.3 kPa (kappa = 0.015, p=0.9). Sensitivity and specificity of FS values to predict LIC were high at cutoff values ranging between 3.2 to 3.75 kPa but decreased markedly at higher cutoff values. On comparing sensitivity and specificity of FS values in prediction of iron overload at different cutoff values by ROC curve, it could not significantly predict iron overload (p=0.7). No correlations were found between LIC and other variables including SF (r=0.2), and changes in SF were not significantly associated with changes in LIC values (p =0.089). However, sensitivity and specificity of SF in predicting LIC were good at cutoff 1003.85 ng/ml but decreased markedly at higher cutoff values. Comparing its sensitivity and specificity to that of SF in the prediction of iron overload at different cutoff values by ROC curve, FS could not predict iron overload accurately (p=0.9) and the degree of agreement between these two variables as indicators of iron overload was low (kappa=0.063, p=0.478). Conclusion: Fibroscan could be a valuable tool to assess the degree of liver fibrosis in patients with elevated SF, but it does not appear to reliably predict LIC in such group of patients especially with severe iron overload. FS values were not affected by disease type, age above 12 years, or HCV sero-positivity. Figure Figure. Disclosures No relevant conflicts of interest to declare.

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Transient Elastography (Fibroscan®) In Adult Patients with Inherited Bleeding Disorders and Chronic Hepatitis C.

Blood ◽

10.1182/blood.v116.21.1413.1413 ◽

2010 ◽

Vol 116 (21) ◽

pp. 1413-1413

Author(s):

Maria Elisa Mancuso ◽

Alessio Aghemo ◽

Paolo Bucciarelli ◽

Elena Santagostino ◽

Mariagrazia Rumi ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Liver Fibrosis ◽

Success Rate ◽

Predictive Value ◽

Transient Elastography ◽

Liver Stiffness ◽

Bleeding Disorders ◽

Non Invasive ◽

Severe Fibrosis

Abstract Abstract 1413 Hepatitis virus C (HCV) infection is common in patients with inherited bleeding disorders due to the past use of plasma-derived clotting factor concentrates not treated with virucidal methods. The prognosis of the infection and the outcome of antiviral therapy are related to the stage of liver fibrosis. Since liver biopsy, the gold standard to grade fibrosis, is rarely performed in these patients for cost-benefit reasons, it is important to consider non invasive methods to assess fibrosis such as liver stiffness measurement with transient elastography (TE, Fibroscan®), a technique already validated in non hemophilic patients. We measured TE in 170 patients with inherited bleeding disorders and HCV infection (positive serum HCV-RNA). The main characteristics of these patients are reported in the Table. Steatosis was detected by abdominal ultrasound. Cirrhosis was defined by the presence of irregular liver edge, splenomegaly, dilated portal vein and/or esophageal varices combined either with low platelet count and/or reduced albumin/cholinesterase levels. TE was successfully performed in all but 3 patients, 2 of whom for Body Mass Index (BMI) > 30 kg/m2. Overall, the median value of liver stiffness was 7.2 kPa (interquartile range, IQR: 5.3–11.1) with a median success rate of 100% (IQR: 91–100) and a median IQR value of 1.0 (IQR: 0.7–1.9). HCV genotype or the presence of steatosis did not influence the TE values, whereas higher values were observed in patients with cirrhosis than in those without (median 19.8 kPa, IQR: 14.3–28.1 vs 6.8 kPa, IQR: 5.1–9.1, respectively; p< 0.01). In particular, 18/22 (82%) cirrhotic patients had a liver stiffness value ≥ 12.0 kPa, a cut-off previously identified as associated with severe fibrosis in HCV infected patients. Overall, splenomegaly was present in 51 patients (30%), 16 with cirrhosis and 35 without. In 31/35 (89%) of the latter, TE values were < 12 kPa. Moreover, among patients without cirrhosis, 12 (8%) had TE values ≥ 12 kPa: those patients had ALT and GGT levels significantly higher than patients with TE values < 12 kPa (p<0.05 for both variables). In our cohort TE had a 83% sensitivity, a 95% specificity and a 94% negative predictive value for the detection of severe fibrosis. In the same patients we measured the aspartate aminotransferase-to-platelet ratio index (APRI), a simple non-invasive biochemical marker of liver fibrosis. Median APRI values were significantly higher in patients with cirrhosis than in those without (1.6 vs 0.5, respectively; p<0.01), and a value > 1.5 was observed in 12/22 (55%) patients with cirrhosis. An APRI >1.5 had a 96% specificity and a 93% negative predictive value for the detection of severe fibrosis. Univariate and multivariate linear regression analyses were performed to investigate the relationship between log transformed TE and demographic (age, BMI) or laboratory (ALT, GGT, APRI) variables potentially influencing the TE values. By univariate analysis a linear association was found with age, ALT, GGT, APRI and BMI values (p<0.01 for each). In multivariate analysis APRI, ALT and GGT showed the strongest association with TE, while the statistical significance for BMI and age was marginal. The entire model explained about 50% of the variance of TE (R2= 0.49). Our results confirm that TE is a good tool to assess liver fibrosis also in patients with inherited bleeding disorders and chronic hepatitis C and shows that it can be performed safely in a great proportion of patients with a high success rate. The value of biochemical markers of necroinflammation (such as ALT and GGT) at the time of TE performance may influence the result and should be taken into account in the interpretation of the test. Disclosures: No relevant conflicts of interest to declare.

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Quantification of Liver Fibrosis, Steatosis, and Viscosity Using Multiparametric Ultrasound in Patients with Non-Alcoholic Liver Disease: A “Real-Life” Cohort Study

Diagnostics ◽

10.3390/diagnostics11050783 ◽

2021 ◽

Vol 11 (5) ◽

pp. 783

Author(s):

Alexandru Popa ◽

Felix Bende ◽

Roxana Șirli ◽

Alina Popescu ◽

Victor Bâldea ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Plane Wave ◽

Transient Elastography ◽

Liver Stiffness ◽

Real Life ◽

Final Analysis ◽

Multivariate Regression Analysis ◽

Alcoholic Fatty Liver ◽

Non Invasive

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. This study aimed to evaluate the performance of four ultrasound-based techniques for the non-invasive multiparametric (MPUS) assessment of liver fibrosis (LF), steatosis (HS), and inflammation in patients with NAFLD. We included 215 consecutive adult patients with NAFLD (mean age: 54.9 ± 11.7; 54.5% were male), in whom LF, HS, and viscosity were evaluated in the same session using four new ultrasound-based techniques embedded on the Aixplorer MACH 30 system: ShearWave Elastography (2D-SWE.PLUS), Sound Speed Plane-wave UltraSound (SSp.PLUS), Attenuation Plane-wave UltraSound (Att.PLUS), and Viscosity Plane-wave UltraSound (Vi.PLUS). Transient Elastography (TE) with Controlled Attenuation Parameter (CAP) (FibroScan) were considered as control. All elastographic measurements were performed according to guidelines. Valid liver stiffness measurements (LSM) were obtained in 98.6% of patients by TE, in 95.8% of patients by 2D-SWE.PLUS/Vi.PLUS, and in 98.1% of patients by Att.PLUS/SSp.PLUS, respectively. Therefore, 204 subjects were included in the final analysis. A strong correlation between LSMs by 2D-SWE.PLUS and TE (r = 0.89) was found. The best 2D-SWE.PLUS cut-off value for the presence of significant fibrosis (F ≥ 2) was 7 kPa. Regarding steatosis, SSp.PLUS correlated better than Att.PLUS with CAP values: (r = −0.74) vs. (r = 0.45). The best SSp.PLUS cut-off value for predicting the presence of significant steatosis was 1524 m/s. The multivariate regression analysis showed that Vi.PLUS values were associated with BMI and LSM by 2D-SWE.PLUS. In conclusion, MPUS was useful for assessing fibrosis, steatosis, and inflammation in a single examination in patients with NAFLD.

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Association of Magnesium Intake with Liver Fibrosis among Adults in the United States

Nutrients ◽

10.3390/nu13010142 ◽

2021 ◽

Vol 13 (1) ◽

pp. 142

Author(s):

Meng-Hua Tao ◽

Kimberly G. Fulda

Keyword(s):

Liver Fibrosis ◽

Calcium Intake ◽

Magnesium Deficiency ◽

Transient Elastography ◽

Liver Stiffness ◽

The United States ◽

Inverse Association ◽

Significant Fibrosis ◽

Magnesium Intake ◽

Total Magnesium

Liver fibrosis represents the consequences of chronic liver injury. Individuals with alcoholic or nonalcoholic liver diseases are at high risk of magnesium deficiency. This study aimed to evaluate the association between magnesium and calcium intakes and significant liver fibrosis, and whether the associations differ by alcohol drinking status. Based on the National Health and Nutrition Examination Survey (NHANES) 2017–2018, the study included 4166 participants aged >18 years who completed the transient elastography examination and had data available on magnesium intake. The median liver stiffness of 8.2 kPa was used to identify subjects with significant fibrosis (≥F2). The age-adjusted prevalence of significant fibrosis was 12.81%. Overall total magnesium intake was marginally associated with reduced odds of significant fibrosis (p trend = 0.14). The inverse association of total magnesium intake with significant fibrosis was primarily presented among those who had daily calcium intake <1200 mg. There were no clear associations for significant fibrosis with calcium intake. Findings suggest that high total magnesium alone may reduce risk of significant fibrosis. Further studies are needed to confirm these findings.

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One-Year Outcomes after Ledipasvir/Sofosbuvir Treatment of Chronic Hepatitis C in Teenagers with and without Significant Liver Fibrosis—A Case Series Report

Viruses ◽

10.3390/v13081518 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1518

Author(s):

Maria Pokorska-Śpiewak ◽

Anna Dobrzeniecka ◽

Magdalena Marczyńska

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Liver Fibrosis ◽

Chronic Hepatitis C ◽

Liver Stiffness ◽

Case Series ◽

Significant Fibrosis ◽

End Of Treatment ◽

One Year ◽

Significant Liver Fibrosis

One-year outcomes after therapy with ledipasvir/sofosbuvir (LDV/SOF) in children with chronic hepatitis C (CHC) presenting with and without significant liver fibrosis were analyzed. We included patients aged 12–17 years treated with LDV/SOF, presenting with significant fibrosis (F ≥ 2 on the METAVIR scale) in transient elastography (TE) at the baseline and we compared the outcomes with that of patients without fibrosis. Patients were followed every 4 weeks during the treatment, at the end of the therapy, at week 12 posttreatment, and one year after the end of treatment. Liver fibrosis was established using noninvasive methods: TE, aspartate transaminase-to-platelet ratio index (APRI), and Fibrosis-4 index (FIB-4). There were four patients with significant fibrosis at baseline: one with a fibrosis score of F2 on the METAVIR scale, and three with cirrhosis (F4) at baseline. One year after the end of treatment, the hepatitis C viral load was undetectable in three of them. One patient was lost to follow-up after week 4. In two out of the four patients, a significant improvement and regression of liver fibrosis was observed (from stage F4 and F2 to F0-F1 on the METAVIR scale). In one patient, the liver stiffness measurement median increased 12 weeks after the end of the treatment and then decreased, but still correlated with stage F4. An improvement in the APRI was observed in all patients. In four patients without fibrosis, the treatment was effective and no progression of fibrosis was observed. A one-year observation of teenagers with CHC and significant fibrosis treated with LDV/SOF revealed that regression of liver fibrosis is possible, but not certain. Further observations in larger groups of patients are necessary to find predictors of liver fibrosis regression.

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Diagnosis of Significant Liver Fibrosis in Patients With Chronic Hepatitis B By Using a Deep Learning-Based Data Integration Network

10.21203/rs.3.rs-1052634/v1 ◽

2021 ◽

Author(s):

Zhong Liu ◽

Huiying Wen ◽

Ziqi Zhu ◽

Qinyuan Li ◽

Li Liu ◽

...

Keyword(s):

Chronic Hepatitis ◽

Deep Learning ◽

Liver Fibrosis ◽

Liver Stiffness ◽

Liver Parenchyma ◽

Ultrasound Images ◽

Clinical Parameters ◽

Non Invasive ◽

Deep Learning Model ◽

Significant Liver Fibrosis

Abstract Background and aims: Chronic hepatitis B virus (CHB) infection remains a major global health burden and the non-invasive and accurate diagnosis of significant liver fibrosis (≥F2) in CHB patients is clinically very important. This study aimed to assess the potential of the joint use of ultrasound images of liver parenchyma, liver stiffness values, and patients’ clinical parameters in a deep learning model to improve the diagnosis of ≥F2 in CHB patients. Methods Of 527 CHB patients who underwent US examination, liver elastography and biopsy, 284 eligible patients were included. We developed a deep learning-based data integration network (DI-Net) to fuse the information of ultrasound images of liver parenchyma, liver stiffness values and patients’ clinical parameters for diagnosing ≥F2 in CHB patients. The performance of DI-Net was cross-validated in a main cohort (n =155) of the included patients and externally validated in an independent cohort (n = 129), with comparisons against single-source data-based models and other non-invasive methods in terms of the area under the receiver-operating-characteristic curve (AUC). Results DI-Net achieved an AUC of 0.943 (95% confidence interval [CI]: 0.893-0.973) in the cross-validation, and an AUC of 0.901 (95% CI: 0.834-0.945) in the external validation, which were significantly greater than those of the comparative methods (AUC ranges: 0.774-0.877 and 0.741-0.848 for cross- and external validations, respectively, Ps < 0.01). Conclusion The joint use of ultrasound images of liver parenchyma, liver stiffness values, and patients’ clinical parameters in a deep learning model could significantly improve the diagnosis of ≥F2 in CHB patients.

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