Noninvasive method to identify fibrosis in chronic Hep C

July's issue of the Journal of Clinical Gastroenterology shows that using simple parameters such as the aspartate to alanine aminotransferase ratio can reduce the need for liver biopsy in Hep C.

Identification of the presence of significant fibrosis is an important part of the diagnostic work-up of patients with chronic Hepatitis C.

Dr Edoardo Giannini and colleagues from Italy evaluated the ability of blood markers to diagnose the presence/absence of significant fibrosis in Hepatits C.

The team of doctors assessed the performance of the aspartate to alanine aminotransferase ratio and platelet count.

The team also evaluated whether these markers reduce the number of liver biopsies.

The large cohort of patients were seen at 2 tertiary referral centers.

The doctors evaluated liver biopsies of 409 patients with chronic Hepatitis C.

Staging was carried out by means of the Ishak and METAVIR scores in the Italian and US series, respectively.

The team observed that the prevalence of significant fibrosis was 43%.

Aspartate to alanine aminotransferase ratio algorithm cutoffs avoid biopsy in 69%

Journal of Clinical Gastroenterology

Aspartate to alanine aminotransferase ratio and platelet count cutoffs had the highest accuracy for the diagnosis of significant fibrosis.

The doctors used these cutoffs to devise a diagnostic algorithm for reducing the number of liver biopsies and diagnosing/ruling out significant fibrosis.

The team found that aspartate to alanine aminotransferase ratios increased and platelet counts decreased as liver fibrosis worsened.

Both aspartate to alanine aminotransferase ratio and platelet count had high accuracy for the diagnosis of significant fibrosis.

The use of aspartate to alanine aminotransferase ratio and platelet count cutoffs in a diagnostic algorithm would have avoided liver biopsy in 69% of the patients.

In addition, the team noted that these cutoff values would have correctly identified the absence/presence of significant fibrosis in 81% of cases.

Dr Giannini's team commented, “In clinical practice, the use of simple, reproducible, and inexpensive parameters such as the aspartate to alanine aminotransferase ratio and platelet count can reduce the need for liver biopsy in a substantial proportion of patients with chronic Hepatitis C.”