Analysis of clinical and virologic features in Hepatitis B e Antigen (HbeAg)-negative and HbeAg-positive Egyptian chronic hepatitis B patients

Background: HBeAg\u2013negative chronic hepatitis B infection has a divergent clinical course from that of HBeAg-positive infection. Objectives: To analyze the frequency and to compare the different features of HBeAg-negative and HBeAg-positive chronic hepatitis B patients. Methods: One hundred and twenty one Egyptian patients with chronic hepatitis B (CHB), underwent laboratory investigations and transient elastography (TE). Comparisons according to HBeAg status were conducted regarding their demographic, liver biochemical and virologic characters. Results: 97 patients (80.2%) were HBeAg-negative while 24 patients (19.8%) were HBeAg-positive. HBeAg-negative patients were significantly older in age than CHBeAg-positive patients (p=0.001). ALT levels in HBeAg-negative patients were significantly lower than those in HBeAg-positive patients (p=0.02), whereas serum albumin was lower in the HBeAg-positive group (p=0.03). The percentage of HBV DNA higher than 20000 IU/mL in HBeAg-negative patients was lower than those in HBeAg-positive patients (p=0.24). Stages of fibrosis by TE showed that 30.9% of HBeAg-negative and 41.7% of HBeAg-positive had a fibrosis score >F2. Four patients (3.3%) were diagnosed with HCC; all of whom were HBeAg-negative. Conclusion: HBeAg-negative patients compared with HBeAg-positive patients had older age, lower ALT and serum HBVDNA levels, but more incidence of HCC

Clinical value of acoustic radiation force impulse elastography in the prediction of hepatocellular carcinoma in chronic hepatitis C patients

Abstract Background and purpose of the study Acoustic radiation force impulse elastography (ARFI) represents an innovative non-invasive tool for the evaluation of liver fibrosis, cirrhosis, and early identification of neoplastic nodules during the follow-up of cirrhotic patients; however, its diagnostic accuracy in the prediction of hepatocellular carcinoma (HCC) is still controversial. Purpose of the study To assess the potential role of ARFI elastography as a non-invasive tool for the prediction of HCC development among chronic hepatitis C (CHC) patients with advanced hepatic fibrosis and liver cirrhosis. Methods The present study recruited 440 patients: 349 CHC patients with advanced hepatic fibrosis and cirrhosis and 91 patients with HCC-related hepatitis C virus (HCV). ARFI-imaging of the liver and transient elastography (TE) was carried out in all patients. ARFI imaging indices include the mean shear wave velocity of HCC, peritumoral parenchyma, and hepatic parenchyma in non-HCC patients. The area under the receiver operating characteristic curve (AUROC) and optimal cutoff values were obtained using a receiver operating characteristic curve analysis to assess the diagnostic performance of ARFI elastography in the predication of HCC. Results The mean hepatic shear wave velocities by ARFI elastography of peri-tumoral cirrhotic hepatic parenchyma were significantly higher than in hepatic parenchyma in non-HCC patients (3.09 vs. 2.26 m/s, p <0.001). The AUROC for the identification of HCC was 0.8, 0.76, 0.76, 0.66, 0.72, and 0.7 for hepatic ARFI elastography, TE, fibrosis-4 score (FIB-4), AST to Platelet Ratio Index (APRI), AST/ALT ratio (AAR), and Age platelets index (API), respectively. Moreover, univariate regression analysis revealed that hepatic ARFI has the highest odd ratio in the prediction of HCC. Conclusion ARFI elastography had a superior diagnostic performance in the prediction of HCC compared to TE and non-invasive markers in CHC patients with advanced fibrosis and cirrhosis, thus putting such patients on the top of the HCC screening list

Performance of Albumin-Bilirubin (ALBI) score in comparison to other non-invasive markers in the staging of liver fibrosis in chronic HCV patients

Abstract Background The prognostic ability of albumin-bilirubin score (ALBI) to assess the hepatic dysfunction in patients with hepatocellular carcinoma (HCC) was previously studied. Its role in the staging of liver fibrosis post chronic hepatitis C Virus (HCV) infection needs to be investigated. Aim to assess the diagnostic value of the ALBI score compared to other non-invasive fibrosis scores in chronic HCV patients. Methods This cross-sectional study included consecutive chronic HCV patients from January 2015 till December 2018. Liver stiffness measurement (LSM) by transient elastography (TE) is currently one of the most validated noninvasive methods for liver fibrosis staging and is used in daily practice as a reference for fibrosis assessment. ALBI grade as well as Fibrosis-4 (FIB-4), Aspartate aminotransferase to platelet ratio index (APRI), LOK index and Göteborg University Cirrhosis (GUCI) scores were calculated for all of the patients. Results A total of 781 chronic HCV patients were included. Around 54% of them had compensated cirrhosis. GUCI score was the most sensitive one to difference between early fibrosis stages, F0 vs. F1. LOK index and ALBI score did not differ significantly between F1 and F2 stages unlike the other study markers. ROC curves revealed good diagnostic capability of FIB-4 (AUROC: 0.85, 0.84), APRI (AUROC: 0.83, 0.83) and GUCI score (AUROC: 0.83, 0.83) for detecting advanced fibrosis and cirrhosis, respectively. ALBI score had a moderate diagnostic role for diagnosing advanced fibrosis and cirrhosis, AUROC of 0.73 and 0.74 respectively. At a cutoff value of -2.95, the sensitivity of ALBI score approached 79%, the specificity was 53% for advanced fibrosis. Conclusion ALBI score has a moderate diagnostic power score in the diagnosis of HCV-associated advanced liver fibrosis and cirrhosis; however, FIB-4, APRI and GUCI scores outperformed the ALBI score

Improvement of platelet in thrombocytopenic HCV patients after treatment with direct-acting antiviral agents and its relation to outcome

Little is known about evolution of platelet count after treatment with direct-acting antiviral agents (DAAs). The study aimed to evaluate the changes in platelet count after treatment with DAAs among thrombocytopenic patients with HCV-related advanced fibrosis and cirrhosis. A total of 915 chronic HCV patients with advanced fibrosis and cirrhosis who were treated with different DAAs-based regimens were retrospectively enrolled in final analysis. Included patients were those with thrombocytopenia (TCP). Platelet count was recorded at baseline, end of treatment (EOT) and 24-weeks after EOT (SVR24). Changes in platelet count and its relation to SVR were analyzed. The overall SVR24 rate was 98.8%. The platelet count showed statistically significant improvement from baseline to EOT (107 (84–127) × 103/mm3 vs. 120 (87–153) × 103/mm3(P = <0.0001) but remained unchanged thereafter to SVR24. Among responders, the platelet count significantly increased at SVR24 compared to baseline (P = <0.0001) but in relapsers, there was improvement in platelet count that didn’t reach statistical significance (P = 0.9). Logistic regression analysis showed that higher Child-Pugh score and more advanced fibrosis at baseline were significant predictors of decreasing of platelet count and development of severe TCP at SVR24. Among thrombocytopenic patients with HCV-related advanced fibrosis and cirrhosis, the platelet count improved after treatment with DAAs regardless to treatment response