Liver stiffness measurement could replace liver biopsy for evaluation of hepatitis C

Non-invasive tests for liver fibrosis, such as liver stiffness measurement or the FibroTest, can predict survival of patients with chronic hepatitis C, according to a new study in Gastroenterology, the official journal of the American Gastroenterological Association (AGA) Institute.

"Liver stiffness measurement and/or the FibroTest could replace liver biopsy for the evaluation of hepatitis C, regardless of the stage of the disease," said Victor de L-dinghen, MD, PhD, of the Centre d' Investigation de la Fibrose H-patique and lead author of this study. "Thus, these tools may help physicians assess prognosis early and discuss specific treatments."

Findings of this study are of major importance since liver stiffness, as a good predictive factor of survival, may help physicians evaluate the severity of liver disease earlier, decide with stronger arguments on a liver transplant or a portosystemic shunt (to bypass the liver), and evaluate more precisely the surgical risk of cirrhotic patients.

In chronic liver diseases, fibrosis assessment predicts liver-related complications and survival. In this study, doctors evaluated the five-year prognostic value of liver stiffness, non-invasive tests of liver fibrosis and liver biopsy to predict overall survival and survival without liver-related death in chronic hepatitis C.

A total of 1,457 patients with chronic hepatitis C were included. At five years, 77 patients died (39 liver-related deaths) and 16 patients had liver transplantation. Overall survival was 91.7 percent and survival without liver-related death was 94.4 percent. Survival was significantly decreased in patients diagnosed with severe fibrosis, no matter which non-invasive method was used.

All methods were able to predict shorter survival times; liver stiffness measurement and results of the FibroTest had higher predictive values. Doctors assessed fibrosis and - on the same day - liver stiffness, performed noninvasive tests of fibrosis (FibroTest, the aspartate aminotransferase to platelet ratio index, FIB-4), and analyzed liver biopsy samples.

"To our knowledge, this study is the first showing that liver stiffness has a prognostic value for overall survival and survival without liver-related death in patients with chronic hepatitis C virus infection," added Dr. L-dinghen. "The present study independently validated the prognostic value of the FibroTest and showed that liver stiffness and FibroTest can predict survival."