Poster Abstracts

BACKGROUND: In the era of novel antiviral drugs for treatment of chronic viral hepatitis C (HCV), the diagnosis of liver cirrhosis guides both the choice of the drug regimen, duration of treatment and subsequent follow up. Transient elastography (TE) (fibroscan) is a recent, non invasive and reliable method for the diagnosis of cirrhosis in patients with chronic HCV. We aimed at demonstrating the agreement of some of the indirect serum markers of liver fibrosis with TE score in staging of liver fibrosis in chronic HCV patients. MATERIALS AND METHODS: One hundred and fifty-nine chronic HCV Egyptian patients were evaluated for antiviral treatment using TE. In all patients, real-time PCR for HCV RNA, liver and renal biochemical tests, PT, INR and CBC were done just before TE (no longer than one month). The stage of liver fibrosis was considered F0 if TE score was 0– 5, F1 if 5.1–7, F2 if 7.1–10, F3 if 10.1–17 and F4 if it was 17.1–75. Liver fibrosis was considered non significant (NSF) if TE score corresponds to F0 or F1. Liver fibrosis was considered significant (SF) if TE score corresponds to F2 or F3. Liver cirrhosis was diagnosed if it corresponded to F4. The indirect serum markers of liver fibrosis examined were AST/Platelet Ratio Index (APRI), Fibrosis 4 score (FIB4) and fibrosis index (FI). APRI was calculated as (AST/upper limit of normal range)/platelet count (10/ L) 9 100 (1). Liver fibrosis was considered significant if APRI score was ≥0.7 and cirrhosis was considered if the score was ≥1 (2). FIB4 score was calculated using the following formula: (Age 9 AST)/(Platelets 9 (sqr(ALT)). If FIB4 score <1.45 = F0–F1. If FIB4 score ≥1.45 and ≤3.25 = F2. If FIB4 score >3.25 = F3–F4 (3). FI was calculated using the following formula: 8.28 [(0.01 9 Platelets (10/L) [1.08 * (10 * serum albumin (g/L))]]. If FI <2.1, no or minimal fibrosis. FI ≥2.1 shows significant fibrosis. FI ≥3.3 predicts cirrhosis (4). The Kappa Statistic was used to assess the method agreement. If Kappa was <0 = less than chance agreement. Kappa 0.01–0.20 = slight agreement. Kappa 0.21–0.40 = fair agreement. Kappa 0.41–0.60 = moderate agreement. Kappa 0.61–0.80 = substantial agreement. Kappa 0.81– 0.99 = almost perfect agreement (5). RESULTS: APRI score agreed with TE score in diagnosis of NSF in 75.8% of cases, in SF in 22.9% and in diagnosis of LC in 84.7% of cases. Kappa was 0.41 denoting moderate agreement. FIB4 agreed with TE score in diagnosis of NSF in 50% of cases, in SF in 52.2% and in diagnosis of LC in 71.2% of cases. Kappa was 0.38 denoting fair agreement. FI agreed with TE score in diagnosis of NSF in 82.1% of cases, in SF in 37.2% and in diagnosis of LC in 47.2% of cases. Kappa was 0.287 denoting fair agreement. CONCLUSIONS: APRI has a better agreement with TE score in staging of liver fibrosis in chronic HCV Egyptian patients than both FIB4 and FI. REFERENCES: 1. Wai CT, Greenson JK, Fontana RJ, et al. A simple non invasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003;38:518–26. 2. Lin ZH, Xin YN, Dong QJ, et al. Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated metaanalysis. Hepatology. 2011Mar;53(3):726–36. 3. Mart ınez SM, Crespo G, Navasa M,et al. Non invasive assessment of liver fibrosis. Hepatology. 2011Jan;53 (1):325–35. 4. Ohta T, Sakaguchi K, Fujiwara A, et al. Simple surrogate index of the fibrosis stage in chronic hepatitis C patients using platelet count and serum albumin level. Acta Med Okayama. 2006 Apr;60(2):77–84. 5. AJ Viera and JM Garrett. Understanding Interobserver Agreement: The Kappa Statistic. FamMed 2005;37 (5):360–3.