Liver stiffness in the hepatitis B virus carrier: a non-invasive marker of liver disease influenced by the pattern of transaminases. World J Gastroenterol. 2008;14:6154-6162. [PMID: 18985805 DOI: 10.3748/wig.14.6154]

Noninvasive models value to the diagnosis of esophageal varices in patients with chronic hepatitis B

AIM

To explore the diagnostic value of noninvasive models for predicting severe esophageal varices in patients with chronic hepatitis B.

METHODS

A total of 140 patients with chronic hepatitis B were included. All of them underwent endoscopic examination, routine blood tests, liver function tests, and blood coagulation tests. Aspartate transaminase (AST)/alanine transaminase (ALT) (AAR model) ratio, AST/platelet (PLT) ratio (APRI model), glutamyl transferase (GGT)/PLT ratio (GPRI model), GGT-PLT-ASB ratio (S-index model), age-PLT related index (API model), age-AST-international sensitivity index (INR)-PLT-ALT ratio (Fibro-Q model), and age-AST-INR-PLT ratio (King model) were evaluated. Upper gastrointestinal endoscopy for esophageal varices was used as the gold standard. The data were used to establish models for receiver operating curve analysis.

RESULTS

The areas under the curve of AAR, GPRI, S-index, APRI, API, Fibro-Q, King's score, and Fibroscan in predicting severe esophageal varices were 0.430, 0.800, 0.801, 0.777, 0.612, 0.750, 0.804, and 0.890, respectively. The prediction performance of GPRI, S-index, King's score and Fibroscan was better with regard to higher sensitivity and specificity and better correlation, with Fibroscan performing best. The areas under the combination of Fibroscan and S-index/King's score/GPRI were 0.899 (P < 0.01), 0.892 (P < 0.01), and 0.891 (P < 0.01), respectively.

CONCLUSION

Noninvasive examinations GPRI, S-index, King's score, and Fibroscan have good diagnostic performance for prediction of esophageal varices. Fibroscan combined with S-index/King's/GPRI has higher predictive value than Fibroscan alone, and can be used as a good alternative to endoscopy.

Non-invasive assessment of liver fibrosis in chronic hepatitis B

The goal of this review is to provide a comprehensive picture of the role, clinical applications and future perspectives of the most widely used non-invasive techniques for the evaluation of hepatitis B virus (HBV) infection. During the past decade many non-invasive methods have been developed to reduce the need for liver biopsy in staging fibrosis and to overcome whenever possible its limitations, mainly: invasiveness, costs, low reproducibility, poor acceptance by patients. Elastographic techniques conceived to assess liver stiffness, in particular transient elastography, and the most commonly used biological markers will be assessed against their respective role and limitations in staging hepatic fibrosis. Recent evidence highlights that both liver stiffness and some bio-chemical markers correlate with survival and major clinical end-points such as liver decompensation, development of hepatocellular carcinoma and portal hypertension. Thus the non-invasive techniques here discussed can play a major role in the management of patients with chronic HBV-related hepatitis. Given their prognostic value, transient elastography and some bio-chemical markers can be used to better categorize patients with advanced fibrosis and cirrhosis and assign them to different classes of risk for clinically relevant outcomes. Very recent data indicates that the combined measurements of liver and spleen stiffness enable the reliable prediction of portal hypertension and esophageal varices development.