Noninvasive Transient Elastography identifies initial stage liver fibrosis & cirrhosis in Hepatitis B patients

Abstract

Background: Among the many non-invasive techniques performed on patients with Hepatitis B Virus (HBV) related fibrosis, the most appropriate results have been obtained using Transient Elastography (FibroScan) to measure liver stiffness. The accurate diagnosis of fibrosis related to HBV is essential for prognostic and therapeutic decisions and offset the limitations of liver biopsy.

Objective: To evaluate Transient Elastography (FibroScan) for detecting and staging hepatic fibrosis by comparing it with hepatic histopathology in patients with Hepatitis B at a tertiary care hospital of Peshawar.

Materials & Methods: A descriptive study was done in March-April 2020 at Rehman Medical Institute, Peshawar, based on retrospective data from May 2016 to March 2020 on 145 HBV positive patients with various stages of hepatic fibrosis who had undergone non-invasive FibroScan during their first visit. Routine demographic, clinical and laboratory parameters were analyzed to predict the existence or absence of advanced fibrosis. At the end of the evaluation, the samples were categorized as F0 (No fibrosis), F1 (Initial fibrosis without septa), F2 (Fibrosis with septa), F3 (Advanced fibrosis) and F4 (Severe fibrosis with cirrhosis, C1). Descriptive data analysis was done by SPSS 17.0.

Results: Out of 145 included patients of chronic hepatitis B, 110 were males and 35 were females. At initial stages the existing laboratory tools diagnosed chronic HBV-infected patients correctly, with minor fibrosis and cirrhosis. Independent indicators of liver fibrosis included platelet count, age, AST, ALT values and albumin; 80% of the patients were not affected by the disease, which means F0 was 80%. Yet some patients had fibrosis at different stages F1, F2, F3, F4 and C1. The FibroScan assessment revealed that out of 145 patients, only 11% patients were at stage F1 whereas the diagnostic value for F2, F3, F4, and C1 are ≤3% with F2=3%, F3=1%, F4=2%, and C1=2%.

Conclusion: FibroScan is an effective method to detect HBV-related fibrosis and cirrhosis; it provided accurate distinction between various stages of fibrosis in Hepatitis B patients.

Keywords: Cirrhosis, Liver; Hepatitis B; Liver Fibrosis; Carcinoma, Hepatocellular.