Analysis of Histopathological Changes that Influence
Liver Stiffness in Chronic Hepatitis C. Results from a Cohort of
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Monica Lupșor1, Radu Badea1, Horia Ștefanescu2, Mircea Grigorescu2,
Zeno Spârchez2, Alexandru Șerban3, Horațiu Brânda1, Sorana Iancu4,
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.