title: Non-invasive methods for the assessment of hepatic fibrosis: transient elastography, hyaluronic acid, 13C-aminopyrine breath test and cytokeratin 18 fragment.
abstract: BACKGROUND. In the management of chronic hepatitis C (CHC) patients, liver biopsy is the gold standard for liver fibrosis assessment despite some technical limits and risks. Non-invasive approaches have been proposed as alternative methods to evaluate structural liver damage. AIM. To investigate the diagnostic accuracy of transient elastography, 13C-aminopyrine breath test (13C-ABT), serum hyaluronic acid (HA) and cytokeratin 18 Asp396 fragment (CK-18) as non-invasive methods of liver fibrosis assessment ad their correlation to METAVIR score. MATERIAL AND METHODS. In a cohort of 57 CHC patients, liver stiffness, cumulative percentage of administered dose of 13C-aminopyrine at 120 min, serum HA and serum CK-18 concentration were determined. Diagnostic accuracy in detecting significant fibrosis (F ≥ 2), severe fibrosis (F ≥ 3) and cirrhosis (F = 4) was assessed by the area under the receiver operating characteristic curve. RESULTS. Liver fibrosis score showed a strong correlation with liver stiffness (r = 0.667; p < 0.0001) and a significant inverse correlation with 13C-ABT results (r = -0.418; p = 0.0012). A weaker correlation was found with CK18 (r = 0.329; p = 0.0126) and no correlation with HA. Areas under the curve of elastography, 13C-ABT, HA and CK18 were: 0.98, 0.75, 0.69, 0.64, respectively, for F ≥ 2; 0.97, 0.69, 0.80, 0.66, respectively, for F ≥ 3; 0.95, 0.64, 0.70, 0.56, respectively, for F = 4. CONCLUSION. Elastography has the best diagnostic accuracy for the assessment of the degree of liver fibrosis in CHC patients. Its application can provide an alternative useful tool for monitoring the disease evolution.
authors.affiliation: Department of Internal Medicine, University of Turin, Turin, Italy.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Caviglia
authors.affiliation: Department of Gastroenterology and Hepatology, San Giovanni Battista University Hospital (Molinette), Turin, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Ciancio
authors.affiliation: Department of Internal Medicine, University of Turin, Turin, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Rosso
authors.affiliation: Department of Internal Medicine, University of Turin, Turin, Italy.
authors.forename: Maria Lorena
authors.initials: ML
authors.lastname: Abate
authors.affiliation: Department of Internal Medicine, University of Turin, Turin, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Olivero
authors.affiliation: Department of Gastroenterology and Hepatology, San Giovanni Battista University Hospital (Molinette), Turin, Italy.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Pellicano
authors.affiliation: Department of Gastroenterology and Hepatology, San Giovanni Battista University Hospital (Molinette), Turin, Italy.
authors.forename: Giovanni Antonio
authors.initials: GA
authors.lastname: Touscoz
authors.affiliation: Department of Gastroenterology and Hepatology, San Giovanni Battista University Hospital (Molinette), Turin, Italy.
authors.forename: Antonina
authors.initials: A
authors.lastname: Smedile
authors.affiliation: Department of Gastroenterology and Hepatology, San Giovanni Battista University Hospital (Molinette), Turin, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
mesh_terms: D000328:Adult; D000368:Aged; D000632:Aminopyrine; D001944:Breath Tests / Q000379:methods; D002247:Carbon Isotopes; D015331:Cohort Studies; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D053538:Keratin-18 / Q000097:blood; D008099:Liver / Q000000981:diagnostic imaging*; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012372:ROC Curve
chemical_list: D002247:Carbon Isotopes; D053538:Keratin-18; D000632:Aminopyrine; D006820:Hyaluronic Acid