CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Clinical pathology abstracts editor: Deborah Sesok-Pizzini, MD, MBA, associate professor, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and medical director, Blood Bank and Transfusion Medicine, Children’s Hospital of Philadelphia.
Combination of blood tests for fibrosis and cirrhosis to assess liver prognosis in CHC
Newer therapies for chronic hepatitis C are promising due to a high rate of sustained viral response and few side effects. Although these therapies are not yet readily available, investigators are considering the best way to evaluate and monitor response. Liver biopsy is often performed in chronic hepatitis C (CHC) patients to assess liver fibrosis. In addition to biopsy, blood fibrosis tests are available and may offer advantages over more invasive testing. The authors conducted a study to compare the prognostic accuracy of several blood fibrosis tests and liver biopsy for predicting liver-related events in CHC patients. A secondary study was conducted to evaluate if the combination of blood fibrosis tests can improve assessment of prognosis. The authors studied 373 patients who had compensated CHC, liver biopsy, and blood tests that target fibrosis or cirrhosis, including APRI, FIB4, Fibrotest, Hepascore, FibroMeter, and CirrhoMeter. The investigators recorded two clinical outcomes in the study: liver-related death and significant liver-related events (SLRE), such as ascites, encephalopathy, jaundice, large esophageal varices, variceal bleeding, hepatorenal syndrome, and hepatocellular carcinoma. The study showed that after a median follow-up of 9.5 years, 47 patients had SLRE and 23 patients died from liver-related disease. For the first SLRE, the blood tests showed a higher prognostication than liver biopsy. Furthermore, multivariate analysis showed FibroMeter, CirrhoMeter, and sustained viral response as independent predictors of the first SLRE. The combination of FibroMeter and CirrhoMeter into a new FM/CM classification improved the liver-prognosis assessment compared to liver biopsy staging or any single tests by identifying five subgroups of patients with significantly different prognoses. The authors concluded that some blood fibrosis tests are more accurate than liver biopsy for determining prognosis in CHC patients. Furthermore, combining two of the fibrosis tests—one diagnostic for fibrosis and the other for cirrhosis—optimizes assessment of liver prognosis.
Boursier J, Brochard C, Bertrais S, et al. Combination of blood tests for significant fibrosis and cirrhosis improves the assessment of liver-prognosis in chronic hepatitis C. Aliment Pharmacol Ther. 2014;40:178–188.
Correspondence: Dr. J. Boursier at jeboursier@chu-angers.fr