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Omar M, Farid K, Emran T, El-Taweel F, Tabll A, Omran M. HCC-Mark: a simple non-invasive model based on routine parameters for predicting hepatitis C virus related hepatocellular carcinoma. Br J Biomed Sci 2021; 78:72-77. [PMID: 33016838 DOI: 10.1080/09674845.2020.1832371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Early detection of hepatocellular carcinoma (HCC) is crucial in providing more effective therapies. As routine laboratory variables are readily accessible, this study aimed to develop a simple non-invasive model for predicting hepatocellular cancer. METHODS Two groups of patients were recruited: an estimation group (n = 300) and a validation group (n = 625). Each comprised two categories: hepatocellular cancer and liver cirrhosis. Logistic regression analyses and receiver operating characteristic (ROC) curves were used to develop and validate the HCC-Mark model comprising AFP, high-sensitivity C-reactive protein, albumin and platelet count. This model was tested in cancer patients classified by the Barcelona Clinic Liver Cancer (BCLC), Cancer of Liver Italian Program (CLIP) and Okuda systems, and was compared with other non-invasive models for predicting hepatocellular cancer. RESULTS HCC-Mark produced a ROC AUC of 0.89 (95% CI 0.85-0.90) for discriminating hepatocellular carcinoma from liver cirrhosis in the estimation group and 0.90 (0.86-0.90) in the validation group (both p < 0.0001). This AUC exceeded all other models, that had AUCs from 0.41 to 0.81. AUCs of HCC-Mark for discriminating patients with a single focal lesion, absent macrovascular invasion, tumour size <2 cm, BCLC (0-A), CLIP (0-1) and Okuda (stage Ι) from cirrhotic patients were 0.88 (0.85-0.90), 0.87 (0.85-0.89), 0.89 (0.85-0.93), 0.87 (0.84-0.89), 0.85 (0.82-0.87) and 0.86 (0.83-0.89), respectively (all p < 0.0001). CONCLUSION HCC-Mark is an accurate and validated model for the detection of hepatocellular cancer and certain of its clinical features.
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Affiliation(s)
- M Omar
- Chemistry Department, Faculty of Science, Damietta University , Damietta, Egypt
| | - K Farid
- Tropical Medicine Department, Faculty of Medicine, Mansoura University , Mansoura, Egypt
| | - T Emran
- Clinical Pathology Department, Faculty of Medicine, Al-Azhar University , Damietta, Egypt
| | - F El-Taweel
- Chemistry Department, Faculty of Science, Damietta University , Damietta, Egypt
| | - A Tabll
- Microbial Biotechnology Department, National Research Centre , Giza, Egypt
- Department of Immunology, Egypt Center for Research and Regenerative Medicine (ECRRM) , Cairo, Egypt
| | - M Omran
- Chemistry Department, Faculty of Science, Helwan University , Cairo, Egypt
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Association of α-fetoprotein levels with liver stiffness measurement in outpatients with chronic hepatitis B. Biosci Rep 2021; 41:227182. [PMID: 33289529 PMCID: PMC7789808 DOI: 10.1042/bsr20203048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/25/2020] [Accepted: 12/07/2020] [Indexed: 02/05/2023] Open
Abstract
The association between α-fetoprotein (AFP) levels with the assessment of liver stiffness (LS) in chronic hepatitis B (CHB) patients were explored. A total of 283 outpatients with CHB were enrolled. Patient age, alanine aminotransferase (ALT), aspartate aminotransferase (AST), AFP, platelet (PLT), total bilirubin (TB), direct bilirubin (DB), alkaline phosphatase (ALP), albumin (ALB), globulin, and albumin/globulin (A/G) levels were associated with LS values in the univariate model (P<0.05). Significant associations between AFP and PLT levels with LS values were observed when both variables were included in the multivariate analysis models. Receiver operation characteristic (ROC) analysis indicated that the combination of AFP and PLT levels could enhance the predictive performance of liver fibrosis (area under the curve (AUC) = 0.819, P<0.001) and that PLT levels (PLT < 100 × 109/l) combined with high AFP levels (AFP > 8 ng/ml) significantly increased the prediction of liver fibrosis (OR = 11.216). More importantly, LS values associated with higher AFP levels (AFP > 8 ng/ml), independently of higher ALT or AST values, were significantly higher than those of low AFP level groups. In conclusion, in Chinese outpatients with CHB, AFP outperformed ALT and/or AST levels in terms of their association with LS. AFP and PLT levels were independently associated with LS, and their combined assessment could enhance the diagnostic and predictive performance of liver fibrosis among CHB patients.
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Liu H, Chen P, Jiang B, Li F, Han T. The value of platelet parameters and related scoring system in predicting esophageal varices and collateral veins in patients with liver cirrhosis. J Clin Lab Anal 2021; 35:e23694. [PMID: 33389784 PMCID: PMC7957998 DOI: 10.1002/jcla.23694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To explore the value of platelet parameters and related scoring system in predicting esophageal varices and collateral veins in patients with liver cirrhosis. Method A total of 94 patients with liver cirrhosis diagnosed in our hospital from March 2017 to July 2018 were divided into without esophageal varices group (NEV) and esophageal varices group (EV) into mild, moderate, and severe subgroups according to the results of general gastroscopy. The differences of biological indexes among different degrees of esophageal varices and collateral veins were analyzed, and the related factors of esophageal varices and collateral veins were analyzed. Results PLT count and PCT decreased gradually with the increase of esophageal varices in EV group. There were significant differences in PLT count and PCT, which were negatively correlated with the degree of collateral vein in esophageal collateral vein group. The maximum cross‐sectional diameter and mean diameter of esophageal collateral veins in EV group were wider than those in NEV group. Further study showed that the maximum cross‐sectional total diameter and mean diameter of esophageal collateral veins in severe esophageal varices group were wider than those in NEV group and mild esophageal varices group. Sequential Logistic regression analysis showed that PCT could effectively predict the existence of esophageal varices. Platelet parameters had no significant diagnostic value in predicting peri‐ECV and Para‐ECV. For platelet‐related FI, APRI, FIB‐4, King, Lok, GUCI, and FibroQ scoring systems, multivariate Logistic regression showed that FI, FIB‐4, Lok and FibroQ scoring systems could effectively predict the presence of EV and Para‐ECV (P<0.05), and its Lok Index is better than other rating systems, with AUROC values of 0.773 and 0.747, respectively. There is no significant predictive value for above scoring systems of peri‐ECV. Conclusions PCT and LOK index can effectively predict the existence of esophageal varices and para‐esophageal veins in patients with liver cirrhosis, and can be used as an effective filling method for common gastroscopy and endoscopic ultrasonography to detect EV and ECV in liver cirrhosis.
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Affiliation(s)
- Huan Liu
- Department of Chronic Liver Disease, Tianjin Second People's Hospital, China
| | - Peng Chen
- Department of Chronic Liver Disease, Tianjin Second People's Hospital, China
| | - Bei Jiang
- Department of Chronic Liver Disease, Tianjin Second People's Hospital, China
| | - Fei Li
- Department of Chronic Liver Disease, Tianjin Second People's Hospital, China
| | - Tao Han
- The Third Central Hospital of Tianjin, Tianjin, China
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Abdelaziz AO, Nabil MM, Omran DA, Abdelmaksoud AH, Asem N, Shousha HI, Elbaz TM, Leithy R. Hepatocellular Carcinoma Multidisciplinary Clinic-Cairo University (HMC-CU) score: A new simple score for diagnosis of HCC. Arab J Gastroenterol 2020; 21:102-105. [PMID: 32439235 DOI: 10.1016/j.ajg.2020.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/31/2019] [Accepted: 04/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND STUDY AIMS The risk of hepatocarcinogenesis depends on background liver factors, of which fibrosis is a major determinant. Serum markers and scores are of increasing importance in non-invasive diagnosis of hepatic fibrosis. Our aim was to predict the occurrence of hepatocellular carcinoma (HCC) using a non-invasive fibrosis score calculated using routine patient data. PATIENTS AND MTHODS Our retrospective study included 1,291 hepatitis C related-HCC Egyptian patients (Group 1) recruited from the multidisciplinary HCC clinic, Faculty of Medicine, Cairo University in the period between February 2009 and June 2016 and 1072 chronic hepatitis C-naïve patients (Group 2) with advanced fibrosis (≥F3) and cirrhosis (F4). King score, Fibro Q score, Aspartate aminotransferase-to-platelet ratio index (APRI), AST to ALT ratio (AAR), LOK score, Göteborg University Cirrhosis Index (GUCI), Fibro-α and Biotechnology Research Center (BRC) scores were calculated for all patients. Regression analysis and receiver operating characteristics (ROC) were used to calculate the sensitivity, specificity and predictive values for significant scores with the best cut-off for predicting HCC. A regression equation was used to calculate predicted probabilities of HCC using the following variables; age, gender, haemoglobin, international normalised ratio (INR), albumin and alpha fetoprotein. The appropriate score cut-off points yielding optimal sensitivity and specificity were determined by ROC curve analysis. RESULTS There was a highly significant difference between the two groups for all calculated scores (P = 0.0001). Our new score, the Hepatocellular Carcinoma Multidisciplinary Clinic-Cairo University (HMC-CU) score (Logit probability of HCC = - 2.524 + 0.152*age - 0.121*Hb - 0.696*INR - 1.059*Alb + 0.022*AFP + 0.976*Sex. Male = 1, Female = 0), with a cut-off of 0.559 was superior to other scores for predicting HCC, having a sensitivity of 90% and specificity of 80.6%. CONCLUSION The HMC-CU score is a promising, easily calculated, accurate, cost-effective score for HCC prediction in chronic HCV patients with advanced liver fibrosis.
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Affiliation(s)
| | | | | | - Ahmed Hosni Abdelmaksoud
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Noha Asem
- Community Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hend Ibrahim Shousha
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Tamer Mahmoud Elbaz
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rania Leithy
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Zhang TT, Ye SS, Liang J, Bai L. Prognostic value of non-invasive fibrosis indices post-curative resection in hepatitis-B-associated hepatocellular carcinoma patients. Exp Biol Med (Maywood) 2020; 245:703-710. [PMID: 32223331 DOI: 10.1177/1535370220914252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPACT STATEMENT Non-invasive fibrosis indices, according to regular laboratory and clinical data, could be useful in assessing liver fibrosis in chronic hepatitis patients. However, the role of these biomarkers remains unclear in predicting the outcome of HBV-associated HCC in patients. This study was carried out retrospectively and included a relatively large sample size (n = 405) with a heterogeneous population of HBV infected patients and longer duration of prospective follow-up. Our study suggested that APRI and Fibro-α Scores are inversely correlated with overall survival in HBV-associated HCC patients. Meanwhile, GUCI, King Score, and APRI were highly correlated with cirrhosis status. Also, in subgroups of cirrhosis or non-cirrhosis, Fibro-α Scores could differentiate patients with good prognosis from those with poor outcome. This result would aid clinicians in acquiring preventive and therapeutic methods in patients with high risk.
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Affiliation(s)
- Ting-Ting Zhang
- Department of Oncology, Peking University International Hospital, Beijing 102206, China
| | - Si-Si Ye
- Department of Oncology, Chinese PLA General Hospital, Beijing 100853, China
| | - Jun Liang
- Department of Oncology, Beijing Cancer Hospital, Beijing 101142, China
| | - Li Bai
- Department of Oncology, Chinese PLA General Hospital, Beijing 100853, China
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Sahin T, Serin A, Emek E, Bozkurt B, Arikan BT, Tokat Y. Effectiveness of Noninvasive Fibrosis Markers for the Prediction of Hepatocellular Carcinoma in Chronic Hepatitis B and Chronic Hepatitis B+D Induced Cirrhosis. Transplant Proc 2019; 51:2397-2402. [DOI: 10.1016/j.transproceed.2019.01.193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/28/2019] [Indexed: 02/07/2023]
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El-Meteini M, Sakr M, Eldorry A, Mohran Z, Abdelkader NA, Dabbous H, Montasser I, Refaie R, Salah M, Aly M. Non-Invasive Assessment of Graft Fibrosis After Living Donor Liver Transplantation: Is There Still a Role for Liver Biopsy? Transplant Proc 2019; 51:2451-2456. [PMID: 31358454 DOI: 10.1016/j.transproceed.2019.01.197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022]
Abstract
Non-invasive methods have evolved as a surrogate for liver biopsy such as indirect markers (aspartate transaminase to platelet ratio index, fibro-α score), transient elastography (TE), and magnetic resonance elastography (MRE). The aim of this study is to prospectively compare the value of MRE, TE, and indirect markers in detecting and staging allograft fibrosis compared to liver biopsies in patients who have undergone living donor liver transplantation for complications related to hepatitis C virus. A total of 31 living donor liver transplantation recipients with hepatitis C virus recurrence underwent a liver biopsy, TE, and MRE within 3 months of a liver biopsy. Fibrosis was assessed according to the biopsy and staged according to Metavir criteria. There was a significant correlation between both MRE and fibro-α scores, as well as histologic classification by liver biopsy (P = .02, .002). The diagnostic accuracy of MRE and fibro-α scores in diagnosing significant fibrosis (F ≥ 3) was measured as the area under the curve (.708 and .833, respectively). Both methods showed good diagnostic performance. TE and aspartate transaminase to platelet ratio index were insignificantly correlated with the degree of fibrosis in liver biopsy (P value of .134, .535). At a cutoff value of 5.5 kPa, MRE predicted graft fibrosis (Metavir stage ≥ 3) with 71.43% sensitivity, 75% specificity, 45.5% positive predictive value, and 90% negative predictive value; at a cutoff value > 1.47, fibro-α scores predicted significant graft fibrosis (Metavir stage ≥ 3) with 85.7% sensitivity and 70.83% specificity, with a positive predictive value of 46.2% and a negative predictive value of 94.4%. These data suggest that non-invasive methods could be considered a reliable tool in assessing significant graft fibrosis post-living donor liver transplantation.
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Affiliation(s)
- M El-Meteini
- Department of Hepatobiliary Surgery & Liver Transplantation, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M Sakr
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - A Eldorry
- Interventional Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Z Mohran
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - N A Abdelkader
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - H Dabbous
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - I Montasser
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - R Refaie
- Internal Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - M Salah
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - M Aly
- Tropical Medicine Department, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Gamil M, Alboraie M, El-Sayed M, Elsharkawy A, Asem N, Elbaz T, Mohey M, Abbas B, Mehrez M, Esmat G. Novel scores combining AFP with non-invasive markers for prediction of liver fibrosis in chronic hepatitis C patients. J Med Virol 2018; 90:1080-1086. [PMID: 29315641 DOI: 10.1002/jmv.25026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 12/09/2017] [Accepted: 12/10/2017] [Indexed: 12/25/2022]
Abstract
Serum levels of alpha-fetoprotein (AFP) were reported to increase in patients with significant or advanced hepatic fibrosis. Combination of non-invasive tests decreases the use of liver biopsy in large proportion of chronic HCV patients. The aim of the study was to compare and combine AFP with commonly used non-invasive fibrosis tests in novel scores for prediction of different stages of hepatic fibrosis. Six hundred and fifty two treatment naïve chronic hepatitis C patients were enrolled. Demographic data, basic pre-treatment laboratory tests including complete blood count (CBC), liver biochemical profile and renal functions test, international normalized ratio (INR) in addition to AFP, liver stiffness measurement (LSM) by Fibroscan and liver biopsies were retrospectively analyzed. AST to Platelet Ratio Index (APRI) and FIB-4 scores were calculated. Different predictive models using multivariate logistic regression analysis were generated and presented in equations (scores) composed of a combination of AFP, LSM plus FIB-4/APRI scores. AFP was correlating significantly with LSM, FIB-4, and APRI scores. Areas under receiver operating characteristic curves (AUROCs) for predicting significant hepatic fibrosis, advanced hepatic fibrosis, and cirrhosis were 0.897, 0.931, and 0.955, respectively, for equations (scores) containing AFP, LSM, and FIB-4. AUROCs for predicting significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis were 0.897, 0.929, and 0.959, respectively, for equations (scores) containing AFP, LSM, and APRI. The study shows that combining AFP to serum biomarkers and LSM increases their diagnostic performance for prediction of different stages of liver fibrosis.
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Affiliation(s)
- Mohamed Gamil
- National Hepatology and Tropical Medicine Research institute, Cairo, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammad El-Sayed
- Department of Endemic Medicine and Hepatology, Cairo University, Cairo, Egypt
| | - Aisha Elsharkawy
- Department of Endemic Medicine and Hepatology, Cairo University, Cairo, Egypt
| | - Noha Asem
- Department of Public Health and Community Medicine, Cairo University, Cairo, Egypt
| | - Tamer Elbaz
- Department of Endemic Medicine and Hepatology, Cairo University, Cairo, Egypt
| | - Mohammad Mohey
- Department of Endemic Medicine and Hepatology, Cairo University, Cairo, Egypt
| | | | - Mai Mehrez
- National Hepatology and Tropical Medicine Research institute, Cairo, Egypt
| | - Gamal Esmat
- Department of Endemic Medicine and Hepatology, Cairo University, Cairo, Egypt
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Attallah AM, Omran D, Omran MM, Albannan MS, Zayed RA, Saif S, Farid A, Hassany M, Yosry A. Fibro-Mark: a panel of laboratory parameters for predicting significant fibrosis in chronic hepatitis C patients. Br J Biomed Sci 2017; 75:19-23. [PMID: 28945150 DOI: 10.1080/09674845.2017.1362950] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Fibrosis markers are useful for the prediction of cirrhosis but clinical scores such as King's score, AST-Platelet ratio index (APRI), Biotechnology research center (BRC), Fibrosis routine test (FRT), Fibro-α score and Fibro-quotient (FibroQ) have limited accuracy for diagnosing significant fibrosis. We hypothesised that new markers (reflecting the balance between hepatic fibrogenesis and fibrolysis) together with other indirect fibrosis markers would together construct a more sensitive and specific score capable of identifying fibrosis than existing scores. METHODS Collagen IV, hyaluronic acid, platelet-derived growth factor (PDGF) and tissue inhibitor of metalloproteinase-1 (TIMP-1) were measured by ELISA, and AST, ALT, platelet count, albumin, total bilirubin, INR and AFP by routine methods in 148 patients with hepatitis C induced liver disease. Stepwise linear discriminant analysis and area under receiver-operating characteristic curves (AUCs) were used to create a predictive score and compare it to others. RESULTS Patients with significant fibrosis (n = 100, F2-F4) showed 2.08, 2.14, 1.80 and 1.90-fold increase in collagen IV, hyaluronic acid, PDGF and TIMP-1, respectively, over patients with no or mild fibrosis (n = 48, F0/F1)(all p < 0.01). Significant independent predictors of F2-F4 were AFP (AUC 0.79), age (0.76), PDGF (0.74), collagen IV (0.78) and TIMP (0.75), which together formed a five-marker score 'Fibro-Mark' for predicting F2-F4. In comparison with other scores, AUC for Fibro-Mark was 0.89, BRC was 0.83, followed by FRT and King's score (both 0.82), APRI (0.80), Fibro-α (0.70) and finally Fibro Q (0.63). CONCLUSIONS The Fibro-Mark score provides better discrimination in hepatic-fibrosis staging in chronic hepatitis C patients than existing scores.
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Affiliation(s)
- A M Attallah
- a Research & Development Dept. , Biotechnology Research Center , New Damietta , Egypt
| | - D Omran
- b Faculty of Medicine, Dept. of Endemic Medicine and Hepatology , Cairo University , Cairo , Egypt
| | - M M Omran
- c Faculty of Science , Helwan University , Cairo , Egypt
| | - M S Albannan
- a Research & Development Dept. , Biotechnology Research Center , New Damietta , Egypt
| | - R A Zayed
- d Faculty of Medicine, Dept. of Clinical and Chemical Pathology , Cairo University , Cairo , Egypt
| | - S Saif
- e National Hepatology and Tropical Medicine Research Institute, Cairo University , Cairo , Egypt
| | - A Farid
- e National Hepatology and Tropical Medicine Research Institute, Cairo University , Cairo , Egypt
| | - M Hassany
- e National Hepatology and Tropical Medicine Research Institute, Cairo University , Cairo , Egypt
| | - A Yosry
- b Faculty of Medicine, Dept. of Endemic Medicine and Hepatology , Cairo University , Cairo , Egypt
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Farid K, Omran MM, Farag RE, Arafa MM, Emran TM. Development and evaluation of a novel score for prediction of large oesophageal varices in patients with hepatitis c virus-induced liver cirrhosis. Br J Biomed Sci 2017; 74:138-143. [DOI: 10.1080/09674845.2017.1297217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- K. Farid
- Faculty of Medicine, Tropical Medicine Department, Mansoura University, Mansoura, Egypt
| | - M. M. Omran
- Faculty of Science, Chemistry Department, Helwan University, Cairo, Egypt
| | - R. E. Farag
- Faculty of Medicine, Tropical Medicine Department, Mansoura University, Mansoura, Egypt
| | - M. M. Arafa
- Faculty of Medicine, Tropical Medicine Department, Mansoura University, Mansoura, Egypt
| | - T. M. Emran
- Faculty of Medicine, Clinical Pathology Department, Al-Azhar University, New Damietta, Egypt
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11
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Mobarak L, Omran D, Nabeel MM, Zakaria Z. Fibro markers for prediction of hepatocellular carcinoma in Egyptian patients with chronic liver disease. J Med Virol 2016; 89:1062-1068. [DOI: 10.1002/jmv.24720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Lamiaa Mobarak
- National Hepatology and Tropical Medicine Research Institute; Cairo Egypt
| | - Dalia Omran
- Faculty of Medicine; Department of Endemic Medicine and Hepato-gastroenterology; Cairo University; Cairo Egypt
| | - Mohammed M. Nabeel
- Faculty of Medicine; Department of Endemic Medicine and Hepato-gastroenterology; Cairo University; Cairo Egypt
| | - Zeinab Zakaria
- Faculty of Medicine; Department of Endemic Medicine and Hepato-gastroenterology; Cairo University; Cairo Egypt
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12
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Mean Platelet Volume, Red Cell Distribution Width to Platelet Count Ratio, Globulin Platelet Index, and 16 Other Indirect Noninvasive Fibrosis Scores: How Much Do Routine Blood Tests Tell About Liver Fibrosis in Chronic Hepatitis C? J Clin Gastroenterol 2016; 50:518-23. [PMID: 26974762 DOI: 10.1097/mcg.0000000000000489] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Many indirect noninvasive scores to predict liver fibrosis are calculated from routine blood investigations. Only limited studies have compared their efficacy head to head. We aimed to compare these scores with liver biopsy fibrosis stages in patients with chronic hepatitis C. MATERIALS AND METHODS From blood investigations of 1602 patients with chronic hepatitis C who underwent a liver biopsy before initiation of antiviral treatment, 19 simple noninvasive scores were calculated. The area under the receiver operating characteristic curves and diagnostic accuracy of each of these scores were calculated (with reference to the Scheuer staging) and compared. RESULTS The mean age of the patients was 41.8±9.6 years (1365 men). The most common genotype was genotype 4 (65.6%). Significant fibrosis, advanced fibrosis, and cirrhosis were seen in 65.1%, 25.6, and 6.6% of patients, respectively. All the scores except the aspartate transaminase (AST) alanine transaminase ratio, Pohl score, mean platelet volume, fibro-alpha, and red cell distribution width to platelet count ratio index showed high predictive accuracy for the stages of fibrosis. King's score (cutoff, 17.5) showed the highest predictive accuracy for significant and advanced fibrosis. King's score, Göteborg university cirrhosis index, APRI (the AST/platelet count ratio index), and Fibrosis-4 (FIB-4) had the highest predictive accuracy for cirrhosis, with the APRI (cutoff, 2) and FIB-4 (cutoff, 3.25) showing the highest diagnostic accuracy.We derived the study score 8.5 - 0.2(albumin, g/dL) +0.01(AST, IU/L) -0.02(platelet count, 10(9)/L), which at a cutoff of >4.7 had a predictive accuracy of 0.868 (95% confidence interval, 0.833-0.904) for cirrhosis. CONCLUSIONS King's score for significant and advanced fibrosis and the APRI or FIB-4 score for cirrhosis could be the best simple indirect noninvasive scores.
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13
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Soresi M, Giannitrapani L, Cervello M, Licata A, Montalto G. Non invasive tools for the diagnosis of liver cirrhosis. World J Gastroenterol 2014; 20:18131-18150. [PMID: 25561782 PMCID: PMC4277952 DOI: 10.3748/wjg.v20.i48.18131] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/22/2014] [Accepted: 11/11/2014] [Indexed: 02/06/2023] Open
Abstract
Liver cirrhosis (LC), the end stage of many forms of chronic hepatitis of different etiologies is a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules surrounded by annular fibrosis. This chronic progressive clinical condition, leads to liver cell failure and portal hypertension, which can favour the onset of hepatocellular carcinoma. Defining the phase of the natural history is crucial for therapeutic choice and prognosis. Liver biopsy is currently considered the best available standard of reference but it has some limits, so alternative tools have been developed to substitute liver biopsy when assessing liver fibrosis. Serum markers offer a cost-effective alternative to liver biopsy being less invasive and theoretically without complications. They can be classified into direct and indirect markers which may be used alone or in combination to produce composite scores. Diagnostic imaging includes a number of instruments and techniques to estimate liver fibrosis and cirrhosis like ultrasound (US), US Doppler, contrast enhanced US and Elastography. US could be used for the diagnosis of advanced LC while is not able to evaluate progression of fibrosis, in this case Elastography is more reliable. This review aims to revise the most recent data from the literature about non invasive methods useful in defining liver fibrosis.
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Impact of contacting study authors to obtain additional data for systematic reviews: diagnostic accuracy studies for hepatic fibrosis. Syst Rev 2014; 3:107. [PMID: 25239493 PMCID: PMC4185334 DOI: 10.1186/2046-4053-3-107] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/29/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Seventeen of 172 included studies in a recent systematic review of blood tests for hepatic fibrosis or cirrhosis reported diagnostic accuracy results discordant from 2 × 2 tables, and 60 studies reported inadequate data to construct 2 × 2 tables. This study explores the yield of contacting authors of diagnostic accuracy studies and impact on the systematic review findings. METHODS Sixty-six corresponding authors were sent letters requesting additional information or clarification of data from 77 studies. Data received from the authors were synthesized with data included in the previous review, and diagnostic accuracy sensitivities, specificities, and positive and likelihood ratios were recalculated. RESULTS Of the 66 authors, 68% were successfully contacted and 42% provided additional data for 29 out of 77 studies (38%). All authors who provided data at all did so by the third emailed request (ten authors provided data after one request). Authors of more recent studies were more likely to be located and provide data compared to authors of older studies. The effects of requests for additional data on the conclusions regarding the utility of blood tests to identify patients with clinically significant fibrosis or cirrhosis were generally small for ten out of 12 tests. Additional data resulted in reclassification (using median likelihood ratio estimates) from less useful to moderately useful or vice versa for the remaining two blood tests and enabled the calculation of an estimate for a third blood test for which previously the data had been insufficient to do so. We did not identify a clear pattern for the directional impact of additional data on estimates of diagnostic accuracy. CONCLUSIONS We successfully contacted and received results from 42% of authors who provided data for 38% of included studies. Contacting authors of studies evaluating the diagnostic accuracy of serum biomarkers for hepatic fibrosis and cirrhosis in hepatitis C patients impacted conclusions regarding diagnostic utility for two blood tests and enabled the calculation of an estimate for a third blood test. Despite relatively extensive efforts, we were unable to obtain data to resolve discrepancies or complete 2 × 2 tables for 62% of studies.
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Alboraie MA, Afifi ME, Elghamry FG, Shalaby HA, Elshennawy GE, Abdelaziz AA, Shaheen MU, Abo El-Seoud AR. Egy-score predicts severe hepatic fibrosis and cirrhosis in Egyptians with chronic liver diseases: a pilot study. HEPATITIS MONTHLY 2013; 13:e10810. [PMID: 24046790 PMCID: PMC3773216 DOI: 10.5812/hepatmon.10810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/02/2013] [Accepted: 04/20/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Non-invasive methods for assessment of hepatic fibrosis are increasingly needed. Recent studies showed that combined elevation of tumor markers CA 19-9 and CA 125 is predictive of severe hepatic fibrosis or cirrhosis with high specificity. OBJECTIVES We aimed at developing a new panel of surrogate biomarkers for prediction of the stage of hepatic fibrosis by combining tumor markers with other known biomarkers of hepatic fibrosis. PATIENTS AND METHODS A total of 92 patients with different types of chronic liver diseases (chronic hepatitis B, chronic hepatitis C and autoimmune hepatitis), were prospectively enrolled in our cohort. They were subjected to: ALT, AST, GGT, ALP, total bilirubin, INR, total cholesterol, albumin, platelet count, cancer antigen 19-9 (CA 19-9), cancer antigen 125 (CA 125), cancer antigen 15-3 (CA 15-3), haptoglobin, alpha-2-macroglobulin, apolipoprotein A1, abdominal ultrasound, liver biopsy and histological staging of hepatic fibrosis using the METAVIR system. RESULTS Combined elevation of CA 19-9 and CA 125 with a summated value > 37 U/mL is predictive of severe hepatic fibrosis or cirrhosis (stage F3-F4 METAVIR) with a probability of 77.6%. Multivariate analysis showed that the most relevant collection of biomarkers for prediction of stage of hepatic fibrosis is: CA 19-9, age, alpha-2- macroglobulin, total bilirubin, platelet count & albumin. We developed a new score, named the "Egy-Score", using a regression equation composed of this panel of biomarkers. Egy-Score could differentiate no or early fibrosis (stage F0-F2 METAVIR) from severe fibrosis or cirrhosis (stage F3-F4 METAVIR) with 83.7% accuracy. CONCLUSIONS Non-invasive assessment of hepatic fibrosis could be done using the Egy-Score. Egy-Score could differentiate no or early fibrosis (stage F0-F2 METAVIR) from severe fibrosis or cirrhosis (stage F3 - F4 METAVIR) with 83.7% accuracy.
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Affiliation(s)
- Mohamed A. Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
- Corresponding author: Mohamed A. Alboraie, Department of Internal Medicine, Al-Azhar University, 11651 Cairo, Egypt. Tel: +20-1222717078, Fax: +20-2225104146, E-mail:
| | - Mahmoud E. Afifi
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Helmy A. Shalaby
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | | | | | | | - Amany R. Abo El-Seoud
- Department of Community Medicine and Public Health, Zagazig University, Zagazig, Egypt
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Attallah AM, El-Far M, Omran MM, Farid K, Albannan MS, El-Dosoky I. Noninvasive diagnosis of liver fibrosis and cirrhosis in chronic hepatitis C patients. J Clin Lab Anal 2013; 27:121-9. [PMID: 23460258 DOI: 10.1002/jcla.21572] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 12/14/2012] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND We aimed to derive a simple noninvasive test for liver-fibrosis staging and then estimate its performance against four simple noninvasive tests in chronic hepatitis C (CHC) patients. METHODS CHC patients were divided into two cohorts: an estimation set (n = 324) and a validation set (n = 524). Liver fibrosis was staged according to the METAVIR scoring system. Statistical analysis was done using stepwise linear discriminant analysis and area under receiver-operating characteristic curves (AUCs). RESULTS Biotechnology Research Center (BRC) score was constructed combining several blood markers that proved useful to stage liver fibrosis. Aspartate aminotransferase /alanine aminotransferase ratio (AAR), aspartate to platelet ratio index (APRI), Fibro-α, King, and BRC scores correlated with the histological fibrosis stages with correlation coefficient 0.26, 0.36, 0.58, 0.45, and 0.73, respectively. BRC score produced AUCs 0.87, 0.83, and 0.89 for significant (F2-F4), advanced fibrosis (F3-F4), and cirrhosis (F4), respectively. These results were reproduced in the validation study with no significant difference yielding AUCs 0.85 for F2-F4, 0.82 for F3-F4, and 0.88 for F4. CONCLUSION BRC score, a novel noninvasive test, is a useful and easy tool to evaluate liver fibrosis in CHC patients and seems more efficient than AAR, APRI, Fibro-α score, and King's score in this group of Egyptian patients.
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Affiliation(s)
- Abdelfattah M Attallah
- Research & Development Department, Biotechnology Research Center, New Damietta City, Egypt.
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Albertoni G, Arnoni CP, Latini FRM, Andrade SS, Araújo PRB, Rodrigues FK, Rozenchan PB, Mendes-Correa MC, Leite OHM, Schor N, Girão MJCB, Barreto JA. Altered of apoptotic markers of both extrinsic and intrinsic pathways induced by hepatitis C virus infection in peripheral blood mononuclear cells. Virol J 2012; 9:314. [PMID: 23256595 PMCID: PMC3554545 DOI: 10.1186/1743-422x-9-314] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 12/07/2012] [Indexed: 01/09/2023] Open
Abstract
Background Chronic hepatitis C (CHC) has emerged as a leading cause of cirrhosis in the U.S. and across the world. To understand the role of apoptotic pathways in hepatitis C virus (HCV) infection, we studied the mRNA and protein expression patterns of apoptosis-related genes in peripheral blood mononuclear cells (PBMC) obtained from patients with HCV infection. Methods The present study included 50 subjects which plasma samples were positive for HCV, but negative for human immunodeficiency virus (HIV) or hepatitis B virus (HBV). These cases were divided into four groups according to METAVIR, a score-based analysis which helps to interpret a liver biopsy according to the degree of inflammation and fibrosis. mRNA expression of the studied genes were analyzed by reverse transcription of quantitative polymerase chain reaction (RT-qPCR) and protein levels, analyzed by ELISA, was also conducted. HCV genotyping was also determined. Results HCV infection increased mRNA expression and protein synthesis of caspase 8 in group 1 by 3 fold and 4 fold, respectively (p < 0.05). In group 4 HCV infection increased mRNA expression and protein synthesis of caspase 9 by 2 fold and 1,5 fold, respectively (p < 0.05). Also, caspase 3 mRNA expression and protein synthesis had level augumented by HCV infection in group 1 by 4 fold and 5 fold, respectively, and in group 4 by 6 fold and 7 fold, respectively (p < 0.05). Conclusions HCV induces alteration at both genomic and protein levels of apoptosis markers involved with extrinsic and intrinsic pathways.
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