Analysis of Histopathological Changes that Influence Liver Stiffness in Chronic Hepatitis C. Results from a Cohort of 324 Patients

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Monica Lupșor1, Radu Badea1, Horia Ștefanescu2, Mircea Grigorescu2, Zeno Spârchez2, Alexandru Șerban3, Horațiu Brânda1, Sorana Iancu4, Anca Maniu1

1) Department of Ultrasonography;
2) Department of Hepatology;
3) Department of Pathology, 3rd Medical Clinic, University of Medicine and Pharmacy, Cluj-Napoca;
4) Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands


Aim. The current study aims to assess the role of the histological parameters in liver biopsy for explaining the variance of liver stiffness, as well as the performance of transient elastography in quantifying liver fibrosis in patients with chronic hepatitis C.

Methods. 324 consecutive CHC patients were prospectively included in this study. All of them had positive HCV-RNA in serum and had underwent percutaneous liver biopsy for grading and staging the diseases (METAVIR scoring system). All were referred to liver stiffness measurement 1 day prior to biopsy.

Results. Liver stiffness values were strongly correlated with fibrosis (r=0.759, p<0.0005). They also correlated with steatosis (r=0.255, p<0.0005), necroinflammatory activity (r=0.378, p<0.0005) and hepatic iron deposition (r=0.143, p=0.03). The univariate regression analysis demonstrated that fibrosis (R2=0.610, p<0.0005), activity (R2=0.145, p<0.0005) and steatosis (R2=0.037, p=0.002) were correlated with liver stiffness. In multiple regression analysis, all three variables independently influenced liver stiffness: fibrosis (p<0.0005), activity (p=0.039) and steatosis (p=0.025). Together they explained 62.4% of the variance of the liver stiffness. The areas under ROC curve for the diagnosis of fibrosis F=1, F=2, F=3, and F=4 were 0.936, 0.862, 0.910 and 0.938, for the cut-off values of 4.9 kPa, 7.4 kPa, 9.1 kPa and 11.85 kPa respectively.

Conclusions. Transient elastography is a useful method for chronic hepatitis C assessment. Fibrosis is the main predictor of liver stiffness, but activity and steatosis also influence liver stiffness.

Chronic hepatitis C - noninvasive - fibrosis - transient elastography - liver stiffness.