The applicability of non-invasive methods for assessing liver fibrosis in hemodialysis patients with chronic hepatitis C.

Abstract

BACKGROUND:

The accurate assessment of liver fibrosis among hemodialysis patients with chronic hepatitis C (CHC) is important for both treatment and for follow up strategies. Applying the non-invasive methods in general population with viral hepatitis have been successful but the applicability of the aminotransferase/platelet ratio index (APRI) or the fibrosis-4 index (FIB-4) in hemodialysis patients need further evaluation.

MATERIALS AND METHODS:

We conducted a prospective, multi-center, uremic cohort to verify the applicability of APRI and FIB-4 in identifying liver fibrosis by reference with the standard transient elastography (TE) measures.

RESULTS:

There were 116 CHC cases with valid TE were enrolled in our analysis. 46 cases (39.6%) were classified as F1, 35 cases (30.2%) as F2, 11 cases (9.5%) as F3, and 24 cases (20.7%) as F4, respectively. The traditional APRI and FIB-4 criteria did not correctly identify liver fibrosis. The optimal cut-off value of APRI was 0.28 and of FIB-4 was 1.91 to best excluding liver cirrhosis with AUC of 76% and 77%, respectively. The subgroup analysis showed that female CHC hemodialysis patients had better diagnostic accuracy with 74.1% by APRI. And CHC hemodialysis patients without hypertension had better diagnostic accuracy with 78.6% by FIB-4.

CONCLUSIONS:

This study confirmed the traditional category level of APRI and FIB-4 were unable to identify liver fibrosis of CHC hemodialysis patients. With the adjusted cut-off value, APRI and FIB-4 still showed suboptimal diagnostic accuracy. Our results suggest the necessary of TE measures for liver fibrosis in the CHC uremic population.

• Authors: Jia-Jung Lee, Yu-Ju Wei, Ming-Yen Lin, Sheng-Wen Niu, Po-Yao Hsu, Jiun-Chi Huang, Tyng-Yuan Jang, Ming-Lun Yeh, Ching-I Huang, Po-Cheng Liang, Yi-Hung Lin, Ming-Yen Hsieh, Meng-Hsuan Hsieh, Szu-Chia Chen, Chia-Yen Dai, Zu-Yau Lin, Shinn-Cherng Chen, Jee-Fu Huang, Jer-Ming Chang, Shang-Jyh Hwang, Chung-Feng Huang, Yi-Wen Chiu, Wan-Long Chuang, Ming-Lung Yu
• Journal: PloS one (PLoS One) Vol. 15 Issue 11 Pg. e0242601 ( 2020) ISSN: 1932-6203 [Electronic] United States
• PMID: 33216807 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Aspartate Aminotransferases

Topics

• Aged
• Aspartate Aminotransferases (blood)
• Female
• Hepacivirus (isolation & purification)
• Hepatitis B virus (isolation & purification)
• Hepatitis C, Chronic (pathology)
• Humans
• Liver (pathology)
• Liver Cirrhosis (diagnosis, pathology)
• Male
• Middle Aged
• Platelet Count
• Prospective Studies
• Renal Dialysis
• Severity of Illness Index