Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Wroblewski, T.
Evaluation of four simple noninvasive tests for prediction of fibrosis in chronic hepatitis C with persistently normal ALT (PNALT)
[ Diplomarbeit ] Medical University of Graz, 2011. pp. 107
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Lackner Karoline
- Altmetrics:
- Abstract:
- Background: The prognosis of hepatitis C and the risk of developing cirrhosis are related to the stage of fibrosis. Liver biopsy is the gold standard for the assessment of histological activity and stage of disease, however, it has potential risks due to its invasive nature and histological assessment may suffer from sampling error and variability of results. Hence, accurate noninvasive tests to predict the stage of fibrosis are desired, especially in patients with persistently normal ALT who tend to show a slower progression of disease. Many noninvasive tests were proposed to predict fibrosis and cirrhosis, partially with high diagnostic accuracies, but only few studies are available for patients with persistently normal ALT. The aim of the current study was to evaluate the diagnostic performance of four noninvasive tests (AAR, APRI, FIB-4, Model 3) and platelet count per se in this particular group of patients. Methods: Liver biopsy specimens of 103 patients enrolled in a previous study were examined applying the Ishak and METAVIR scoring systems for grading and staging. Descriptive data analysis and the evaluation of diagnostic accuracies of the noninvasive fibrosis tests and platelet count have been evaluated for the whole population as well as for subgroups of patients with persistently normal and elevated ALT.Results: Receiver operating characteristic curve analysis revealed comparable diagnostic accuracies of all noninvasive tests and platelet count for prediction of significant fibrosis and cirrhosis in the total study population and in the subgroup of patients with elevated ALT. AAR was a poor predictor of fibrosis and cirrhosis in all our study groups. In patients with persistently normal ALT, areas under the curve were close to or under the reference line for all noninvasive fibrosis tests. The subgroup of patients with persistently normal ALT comprised patients with almost exclusively low fibrosis stages which hampered an adequate evaluation of the noninvasive tests. Conclusion: Simple noninvasive tests to predict fibrosis and cirrhosis can substitute liver biopsy only in a fractional part of patients with hepatitis C. We could confirm the applicability of APRI, FIB-4, Model 3 and platelet count in patients with elevated ALT and in our whole population. Yet, we could not confirm their applicability in the subgroup of patients with persistently normal ALT.