Kastamonu Medical Journal regularly publishes internationally qualified issues in the field of Medicine in the light of up-to-date information.

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Original Article
The contribution of imaging to non-invasive fibrosis biomarkers in the diagnosis and staging of chronic liver disease
Aims: Gold standard technique for determining the stage of fibrosis in cirrhosis is a biopsy. Non-invasive tests are used when a biopsy is contraindicated. However, their specificity and sensitivity still fall short of expectations. Aim of the study is to develop a model capable of determining fibrosis using serum biomarkers and liver ultrasonography.
Methods: A retrospective study was designed including patients with chronic hepatitis B and C underwenting liver biopsies between the time frame of 2015 to 2020 years at Trakya University School of Medicine. Epidemilogical data, ltrasonography and pathology reports were noted. Blood values were recorded and used to calculate AST / Platelet Ratio Index (APRI), Fibrosis-4 Index (FIB-4), Gothenburg University Cirrhosis Index (GUCI) noninvasive fibrosis indices. The fibrosis stages of the patients were assessed accoridng to pathology reports into three categories: advanced (F5-F6), moderate (F3-F4), and lower Ishak scores.
Results: A total of 259 patients were included in the study. The median age of the patients was 54 (19-90), and 40.9% (106) were female. The median values of APRI, GUCI and FIB-4 scores were respectively: 0.6 (0-21.8), 0.6 (0-26.2) and 1.6 (0.2-8.5). The effects of ultrasonography findings were examined to improve the diagnostic performance of APRI, GUCI and FIB-4 indices. Accompanied by statistical analysis, it was observed that the FIB-4 index and the presence of hepatosteatosis in the liver had a significant effect on the detection of F?3 (respectively; p<0.001, p=0.033). A new model named FIB4u (ultrasonography) was developed. The AUC values of indices for differentiation of intermediate and advanced stages of fibrosis (?3) were respectively:FIB4u 0.760; FIB-4 0.753; GUCI 0.676; APRI 0.667 (p<0.001). The FIB4u index demonstrated considerably better performance compared to both APRI and GUCI.
Conclusion: The FIB4u index, developed by combining ultrasonography and laboratory data, can be used as a new index for fibrosis assessment in the absence of advanced elastography techniques. It needs to be validated in larger patient cohorts to be used safely in the long term.

1. Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases inthe world. J Hepatol. 2019;70(1):151-171. doi: 10.1016/j.jhep.2018.09.014
2. Younossi ZM, Stepanova M, Rafiq N, et al. Pathologic criteria fornonalcoholic steatohepatitis: interprotocol agreement and ability to predictliver-related mortality. Hepatol. 2011;53(6):1874-1882. doi: 10.1002/hep.24268
3. Yano M, Kumada H, Kage M, et al. The long-term pathological evolutionof chronic hepatitis C. Hepatol. 1996;23(6):1334-1340. doi: 10.1002/hep.510230607
4. Almpanis Z, Demonakou M, Tiniakos D. Evaluation of liver fibrosis:&ldquo;Something old, something new&hellip;&rdquo;. Ann Gastroenterol. 2016;29(4):445-453. doi: 10.20524/aog.2016.0046
5. European Association for Study of Liver. EASL-ALEH Clinical PracticeGuidelines: Non-invasive tests for evaluation of liver disease severity andprognosis. J Hepatol. 2015;63(1):237-264. doi: 10.1016/j.jhep.2015.04.006
6. Poynard T, Munteanu M, Deckmyn O, et al. Applicability and precautionsof use of liver injury biomarker FibroTest. A reappraisal at 7 years of age.BMC Gastroenterol. 2011;11(1):39. doi:10.1186/1471-230X-11-39
7. Imbert-Bismut F, Messous D, Thibault V, et al. Intra-laboratory analyticalvariability of biochemical markers of fibrosis (Fibrotest) and activity(Actitest) and reference ranges in healthy blood donors. Clin Chem LabMed. 2004;42(6):681. doi: 10.1515/CCLM.2004.058
8. Saglam S. The value of non-invasive serum biomarkers for predictingliver fibrosis and necroinflammation in chronic hepatitis B patients,development a new model. Master Thesis. Turkiye. Ulusal Tez Merkezi2019 [cited 2023 July 9]. Available from: https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYeni.jsp
9. Okuda M, Li K, Beard MR, et al. Mitochondrial injury, oxidative stress,and antioxidant gene expression are induced by hepatitis C virus coreprotein. Gastroenterol. 2002;122(2):366-375. doi: 10.1053/gast.2002.30983
10. Pohl A, Behling C, Oliver D, Kilani M, Monson P, Hassanein T. Serumaminotransferase levels and platelet counts as predictors of stage offibrosis in chronic hepatitis C virus infection. Am J Gastroenterol.2001;96(11):3142-3146. doi: 10.1111/j.1572-0241.2001.05268.x
11. Eminler AT, Irak K, Ayyildiz T, et al. The relation between liver histopathologyand GGT levels in viral hepatitis: more important in hepatitis B. Turk JGastroenterol. 2014;25(4):411-415. doi: 10.5152/tjg.2014.3693
12. Korkmaz P, Demirturk N, Batırel A, et al. Noninvasive models to predictliver fibrosis in patients with chronic hepatitis B: a study from Turkiye.Hepat Mon. 2017;17(12):e60266. doi: 10.5812/hepatmon.60266
13. Iacobellis A, Fusilli S, Mangia A, et al. Ultrasonographic and biochemicalparameters in the non-invasive evaluation of liver fibrosis in hepatitis Cvirus chronic hepatitis. Aliment Pharmacol Ther. 2005;22(9):769-774. doi:10.1111/j.1365-2036.2005.02633.x
14. Ayg&uuml;n C, G&ouml;zel N, Demirel U, Yalniz M, &Ouml;zercan İH, &amp; BahcecioğluİH. Kronik viral hepatit B tanısı olan hastalarda serum GGT d&uuml;zeyi ilekaraciğer fibrozu ilişkisi. Fırat Tıp Derg. 2010;15(2):74-78.
15. Karasu Z, Tekin F, Ersoz G, et al. Liver fibrosis is associated with decreasedperipheral platelet count in patients with chronic hepatitis B and C. DigDis Sci. 2007;52(6):1535-1539. doi: 10.1007/s10620-006-9144-y
16. Lu LG, Zeng MD, Wan MB, et al. Grading and staging of hepatic fibrosis,and its relationship with noninvasive diagnostic parameters. World JGastroenterol. 2003;9(11):2574-2578. doi: 10.3748/wjg.v9.i11.2574
17. Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index canpredict both significant fibrosis and cirrhosis in patients with chronichepatitis C. Hepatol. 2003;38(2):518-526. doi: 10.1053/jhep.2003.50346
18. Zhu X, Wang LC, Chen EQ, et al. Prospective evaluation of FibroScan forthe diagnosis of hepatic fibrosis compared with liver biopsy/AST plateletratio index and FIB-4 in patients with chronic HBV infection. Dig Dis Sci.2011;56(9):2742-2749. doi: 10.1007/s10620-011-1659-1
19. Islam S, Antonsson L, Westin J, Lagging M. Cirrhosis in hepatitis Cvirus-infected patients can be excluded using an index of standardbiochemical serum markers. Scand J Gastroenterol. 2005;40(7):867-872.doi: 10.1080/00365520510015674
20. Kandemir &Ouml;, Polat G, Sara&ccedil;oğlu G, Taşdelen B. The predictive role of ASTlevel, prothrombin time, and platelet count in the detection of liver fibrosisin patients with chronic hepatitis C. Turkish J Med Sci. 2009;39(6):857-862. doi: 10.3906/sag-0902-11
21. Sterling RK, Lissen E, Clumeck N, et al. Development of a simplenoninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatol. 2006;43(6):1317-1325. doi: 10.1002/hep.21178
22. Vallet-Pichard A, Mallet V, Nalpas B, et al. FIB-4: an inexpensive andaccurate marker of fibrosis in HCV infection. comparison with liverbiopsy and fibrotest. Hepatol. 2007;46(1):32-36. doi: 10.1002/hep.21669
23. Guidelines for the Prevention, Care and Treatment of Persons withChronic Hepatitis B Infection. Geneva: World Health Organization; 2015Mar. Available from: https://www.ncbi.nlm.nih.gov/books/NBK305553/
Volume 4, Issue 1, 2024
Page : 15-18