Role of Non-Invasive Scoring Systems in Detecting Fibrosis in Chronic Hepatitis B

INTRODUCTION: Although liver biopsy is the gold standard diagnostic method for fibrosis, it is seen disadvantageous for risk of complications, high cost, and pathology result not reflecting the whole liver. Hence, the need to develop noninvasive methods to detect fibrosis has arisen. The aim is evaluate the power of scores developed using laboratory tests in predicting the severity of fibrosis in hepatitis B patients.
METHODS: In this study 171 patients diagnosed with Chronic Hepatitis B, had liver biopsy and had simultaneous laboratory tests were evaluated. To evaluate the difference between the variables, patients were divided into two groups as those with mild fibrosis (fibrosis score <2) and those with advanced fibrosis (fibrosis score ≥ 2). Between these two groups, Aspartate Aminotransferase - Alanine Aminotransferase ratio (AAR), AST Platelet Ratio Index (APRI), Fibrosis 4 Score (FIB-4), Age-Platelet Index (API), University of Goteborg cirrhosis index (GUCI), Cirrhosis Discriminant Score (CDS) and King Score were compared.
RESULTS: The median age of the patients is 31 in fibrosis 0-1 and 33 in fibrosis 2-3-4-5. There were 74 patients (43.2%) with mild fibrosis and 97 patients (56.7%) with advanced fibrosis. There was no significant difference between the two groups in terms of FIB-4, AAR, API, APRI, CDS, GUCI and King scores. DNA levels of HBV were significantly higher in advanced fibrosis.
DISCUSSION AND CONCLUSION: AAR, APRI, FIB-4, API, GUCI, CDS and King's scores were not sufficient to predict the severity of fibrosis in patients with HBV infection; however, serum HBV DNA levels were better in predicting fibrosis compared to these scores.

Kronik Hepatit B Hastalarýnda Fibrozisi Belirlemede Noninvazif Skorlama Sistemlerinin Yeri

GÝRÝÞ ve AMAÇ: Karaciðer biyopsisi fibrozisi tanýmlamada altýn standart taný yöntemi olmasýna karþýn komplikasyon riskinin olmasý, maliyetinin yüksek olmasý, patoloji sonucunun karaciðerin tamamýný yansýtmamasý gibi nedenlerden dolayý dezavantajlý olarak görülmektedir. Bu nedenle fibrozisi belirlemede noninvaziv taný yöntemlerinin geliþtirilmesi ihtiyacý doðmuþtur. Bu çalýþmada amacýmýz hepatit B hastalarýnda fibrozis ciddiyetini öngörmede, laboratuvar tetkikleri kullanýlarak geliþtirilmiþ skorlarýn güçlerini deðerlendirmektir.
YÖNTEM ve GEREÇLER: Kronik hepatit B (KHB) tanýlý; karaciðer biyopsisi yapýlýp eþ zamanlý laboratuvar tetkikleri olan 171 hasta retrospektif olarak deðerlendirildi. Deðiþkenler arasýnda farký deðerlendirmek amacýyla, hastalar düþük fibrozisi olanlar (fibrozis skoru<2), yüksek fibrozisi olanlar (fibrozis skoru≥ 2) olmak üzere iki gruba ayrýldý. Bu iki grup arasýnda aspartat aminotransferaz– Alanin Aminotransferaz oraný (AAR), AST trombosit oraný indeksi (APRI), fibrozis 4 skoru (FIB-4), yaþ-trombosit indeksi (API), Goteborg Üniversitesi siroz indeksi (GUCI)ve siroz diskriminant skoru (CDS) ve King skoru karþýlaþtýrýldý.
BULGULAR: Hastalarýn ortanca yaþlarý fibrozis 0-1’de 31, fibrozis 2-3-4-5’te ise 33 idi. Düþük fibrozisi olan 74 hasta (%43.2) ve yüksek fibrozisi olan 97 hasta (%56.7) vardý. FIB-4, AAR, API, APRI, CDS, GUCI ve King skorlarý açýsýndan iki grup arasýnda anlamlý fark yoktu. Bununla birlikte, Hepatit B virus (HBV) DNA düzeyi ileri fibrozisde anlamlý olarak daha yüksek idi.
TARTIÞMA ve SONUÇ: HBV enfeksiyonu olan hastalarda fibrozis ciddiyetini öngörmede AAR, APRI, FIB-4, API, GUCI, CDS ve King’s skorlarýnýn yeterli olmadýðýný; ancak serum HBV DNA seviyelerinin bu skorlara kýyasla fibrozisi öngörmede daha iyi olduðunu belirledik.