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ROLE OF THE FIBROSCAN IN ASSESSING CHRONIC LIVER DISEASES
ROLE OF THE FIBROSCAN IN ASSESSING CHRONIC LIVER DISEASES
Ranj Azad Hama a, Mohammed Omer Mohammed b, and Mohsin A. Mohammed a
a Directorate of Health, Ministry of Health, Sulaimani, Kurdistan Region, Iraq.
b College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.
Submitted: 27/5/2022; Accepted:21/10/2022; Published: 21/12/2022
DOI Link: https://doi.org/10.17656/jsmc.10375
ABSTRACT
Background
Chronic liver disease (CLD) is a long-term inflammatory process of the liver parenchyma. In 2017 it was estimated that 1.5 billion persons had CLD, ranging from most to least common aetiology NAFLD (60%), HBV (29%), HCV (9%), and ALD (2%). The gold standard test for confirming the diagnosis, staging fibrosis, grading activity, and judging response to treatment in CLD is Liver biopsy. However, it has several limitations; as a result, validated noninvasive tests are required. Transient elastography (FibroScan; Echosens, Paris, France) is a new, non-invasive technique for measuring liver stiffness.
Objectives
The aims of the study: To determine the role of Fibroscan in assessing fibrosis and steatosis among a group of patients with chronic liver diseases and compare Fibroscan with other noninvasive methods (APRI, NFS and FIB-4).
Patients and Methods
This cross-sectional study was conducted on 100 patients with chronic liver disease at Kurdistan Centre for Gastroenterology and Hepatology (KCGH). Fibroscan was done in an outpatient clinic in Sulaimaniyah from June 2019- November 2020. Required data were collected from the patients based on their Clinical, laboratory and radiological findings. The collected data were analysed using Statistical Package for the Social Sciences (SPSS version 25.0).
Results
Fifty-nine percent of the patients were males. Causes of CLD among patients were as follows: 58% had hepatitis B virus infection, 18% had hepatitis C virus infection, 16% had nonalcoholic fatty liver disease, 4% had nonalcoholic steatohepatitis, 2% had alcoholic hepatitis, 1% had autoimmune hepatitis, 1% cryptogenic chronic hepatitis. The results revealed a significant association between the results obtained from Fibroscan and FIB-4 (p-value=0.001) and APRI (p-value=0.001). Moreover, the sensitivity and specificity of Fibroscan to FIB-4 were 91.2% and 26.7%, and to APRI were 82.4% and 20%.
Conclusion
There was a significant correlation between Fibroscan and FIB-4, APRI. The degree of fibrosis by Fibroscan had a significant association with platelet (PLT) count, alkaline phosphatase (ALP) and serum albumin. There was a significant association between steatosis grades and incidence of HBV, HCV, NAFLD, NASH and , alcoholic hepatitis.
KEYWORDS
Fibroscan, Transient elastography, Chronic liver disease, APRI, FIB-4.
References
1. Moon AM, Singal AG, Tapper EB. Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2020;18(12):2650-66.
2. Sharma A, Nagalli S. Chronic Liver Disease. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2021, StatPearls Publishing LLC.; 2021.
3. Berger D, Desai V, Janardhan S. Con: Liver Biopsy Remains the Gold Standard to Evaluate Fibrosis in Patients With Nonalcoholic Fatty Liver Disease. Clinical liver disease. 2019;13(4):114-6.
4. Huang R, Jiang N, Yang R, Geng X, Lin J, Xu G, et al. Fibroscan improves the diagnosis sensitivity of liver fibrosis in patients with chronic hepatitis B. Exp Ther Med. 2016;11(5):1673-7.
5. Borsoi Viana MS, Takei K, Collarile Yamaguti DC, Guz B, Strauss E. Use of AST platelet ratio index (APRI Score) as an alternative to liver biopsy for treatment indication in chronic hepatitis C. Annals of hepatology. 2009;8(1):26-31.
6. Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology (Baltimore, Md). 2007;46(1):32-6.
7. Kim IH, Kisseleva T, Brenner DA. Aging and liver disease. Curr Opin Gastroenterol. 2015;31(3):184-91.
8.Tajiri K, Shimizu Y. Liver physiology and liver diseases in the elderly. World journal of gastroenterology. 2013;19(46):8459-67.
9. Wiegand J, Berg T. The etiology, diagnosis and prevention of liver cirrhosis: part 1 of a series on liver cirrhosis. Dtsch Arztebl Int. 2013;110(6):85-91.
10. Modi AA, Liang TJ. Hepatitis C: a clinical review. Oral diseases. 2008;14(1):10-4.
11.Martini A, Ceranto E, Gatta A, Angeli P, Pontisso P. Occult liver disease burden: Analysis from a large general practitioners' database. United European gastroenterology journal. 2017;5(7):982-6.
12. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. The lancet Gastroenterology & hepatology. 2020;5(3):245-66.
13. Guy J, Peters MG. Liver disease in women: the influence of gender on epidemiology, natural history, and patient outcomes. Gastroenterology & hepatology. 2013;9(10):633-9.
14. Hashemi SA, Alavian SM, Gholami-Fesharaki M. Assessment of transient elastography (FibroScan) for diagnosis of fibrosis in non-alcoholic fatty liver disease: A systematic review and meta-analysis. Caspian journal of internal medicine. 2016;7(4):242-52.
15. Nudo CG, Jeffers LJ, Bejarano PA, Servin-Abad LA, Leibovici Z, De Medina M, et al. Correlation of Laparoscopic Liver Biopsy to Elasticity Measurements (FibroScan) in Patients With Chronic Liver Disease. Gastroenterology & hepatology. 2008;4(12):862-70.
16. Talwalkar JA, Kurtz DM, Schoenleber SJ, West CP, Montori VM. Ultrasound-based transient elastography for the detection of hepatic fibrosis: systematic review and meta-analysis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2007;5(10):1214-20.
17. Mallet V, Dhalluin-Venier V, Roussin C, Bourliere M, Pettinelli ME, Giry C, et al. The accuracy of the FIB-4 index for the diagnosis of mild fibrosis in chronic hepatitis B. Alimentary pharmacology & therapeutics. 2009;29(4):409-15.
18. Li Y, Chen Y, Zhao Y. The diagnostic value of the FIB-4 index for staging hepatitis B-related fibrosis: a meta-analysis. PloS one. 2014;9(8):e105728-e.
19. Li X, Xu H, Gao P. Fibrosis Index Based on 4 Factors (FIB-4) Predicts Liver Cirrhosis and Hepatocellular Carcinoma in Chronic Hepatitis C Virus (HCV) Patients. Med Sci Monit. 2019;25:7243-50.
20. Dyson JK, Anstee QM, McPherson S. Non-alcoholic fatty liver disease: a practical approach to diagnosis and staging. Frontline gastroenterology. 2014;5(3):211-8.
21. Loaeza-del-Castillo A, Paz-Pineda F, Oviedo-Cárdenas E, Sánchez-Avila F, Vargas-Vorácková F. AST to platelet ratio index (APRI) for the noninvasive evaluation of liver fibrosis. Annals of hepatology. 2008;7(4):350-7.
22. Xiao G, Yang J, Yan L. Comparison of diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis-4 index for detecting liver fibrosis in adult patients with chronic hepatitis B virus infection: a systemic review and meta-analysis. Hepatology (Baltimore, Md). 2015;61(1):292-302.
23. Shaheen AA, Myers RP. Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis C-related fibrosis: a systematic review. Hepatology (Baltimore, Md). 2007;46(3):912-21.
24. Jun BG, Park WY, Park EJ, Jang JY, Jeong SW, Lee SH, et al. A prospective comparative assessment of the accuracy of the FibroScan in evaluating liver steatosis. PloS one. 2017;12(8):e0182784-e.
25. Lee HW, Park SY, Kim SU, Jang JY, Park H, Kim JK, et al. Discrimination of Nonalcoholic Steatohepatitis Using Transient Elastography in Patients with Nonalcoholic Fatty Liver Disease. PloS one. 2016;11(6):e0157358.
26. Petta S, Cammà C, Di Marco V, Macaluso FS, Maida M, Pizzolanti G, et al. Hepatic steatosis and insulin resistance are associated with severe fibrosis in patients with chronic hepatitis caused by HBV or HCV infection. Liver international : official journal of the International Association for the Study of the Liver. 2011;31(4):507-15.
27. Seidel N, Volkmann X, Länger F, Flemming P, Manns MP, Schulze-Osthoff K, et al. The extent of liver steatosis in chronic hepatitis C virus infection is mirrored by caspase activity in serum. Hepatology (Baltimore, Md). 2005;42(1):113-20.
28. Altlparmak E, Koklu S, Yalinkilic M, Yuksel O, Cicek B, Kayacetin E, et al. Viral and host causes of fatty liver in chronic hepatitis B. World journal of gastroenterology. 2005;11(20):3056-9.
29.Lesmana LA, Lesmana CR, Pakasi LS, Krisnuhoni E. Prevalence of hepatic steatosis in chronic hepatitis B patients and its association with disease severity. Acta medica Indonesiana. 2012;44(1):35-9.
30. Hossain N, Afendy A, Stepanova M, Nader F, Srishord M, Rafiq N, et al. Independent predictors of fibrosis in patients with nonalcoholic fatty liver disease. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2009;7(11):1224-9, 9.e1-2.
31. Paul J, Venugopal RV, Peter L, Shetty KNK, Shetti MP. MEASUREMENT OF CONTROLLED ATTENUATION PARAMETER: A SURROGATE MARKER OF HEPATIC STEATOSIS IN PATIENTS OF NONALCOHOLIC FATTY LIVER DISEASE ON LIFESTYLE MODIFICATION - A PROSPECTIVE FOLLOW-UP STUDY. Arquivos de gastroenterologia. 2018;55(1):7-13.
32. Chalasani N, Wilson L, Kleiner DE, Cummings OW, Brunt EM, Unalp A. Relationship of steatosis grade and zonal location to histological features of steatohepatitis in adult patients with non-alcoholic fatty liver disease. Journal of hepatology. 2008;48(5):829-34.
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