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Traditional systemic therapies and monitoring guidelines
Published in M. Alan Menter, Caitriona Ryan, Psoriasis, 2017
Maria Polina Konstantinou, Carle Paul
The literature does not provide accurate estimates of the incidence of liver fibrosis attributable to methotrexate as relevant studies rarely consider potential confounders common in psoriasis population, such as metabolic syndrome or alcohol consumption.7,8 This incidence, however, seems low.9 In general, clinicians should consider all psoriasis patients taking methotrexate to be at a potential risk of liver fibrosis and screening for additional risk factors should be adopted before prescription (see Table 22.3). Furthermore, during treatment, appropriate monitoring for early detection of fibrosis provides an opportunity to reverse the disease progression. There is uncertainty about the best monitoring method and clinical practice varies.10 The procollagen-3N-terminal peptide (PIIINP) is currently used in Europe11,12 reducing by sevenfold the need for liver biopsies. PIIINP dosing is recommended every 3 months. In case of persistent abnormalities, i.e., PIINP > 4.2 µg/L in at least three samples over a 12-month period, a hepatologist opinion may be taken and a liver biopsy may be considered. Other noninvasive methods are becoming increasingly popular such as fibroscan and fibrotest but they remain to be fully validated.
Chronic viral hepatitis
Published in Nizar Zein, Bret Lashner, The Year in Gastroenterology and Hepatology, 2005
B A C K R o u N D Until recently, liver biopsy was the only diagnostic tool for the G detection of advanced hepatic fibrosis or cirrhosis in patients with chronic HCV infection, and it remains the gold standard against which other tests are compared. Establishing the degree of hepatic fibrosis in HCV patients has significant implications for the management of these patients, including treatment and intervention decisions. Several attempts have been made recently to identify noninvasive predictors of advanced hepatic fibrosis. A combination of simple serum biomarkers for the diagnosis of advanced liver fibrosis has been marketed under the (AT) generic name of Fibrotest'" (FT) (Biopredictive, Houilles, France) and ActitestTM (Biopredictive, Houilles, France). These two tests are gaining broad acceptance in Europe and t o a lesser degree in the US as non-invasive predictors of advanced fibrosis. The FT test combines five serum markers (a,-macroglobulin, haptoglobin, y-glutamyl transpeptidase, bilirubin and apolipoprotein Al), while the AT test combines the same markers of the FT test with ALT and is used as an index of fibrosis and activity. The primary aim of the present study was to assess the diagnostic value (sensitivity, specificity, positive predictive value and negative predictive value) of the FT and A tests in chronic HCV patients before and after T treatment with pegylated IFN and RBV. I N T E R P R E T A T I o N This was a retrospective study using stored serum samples from patients who had been enrolled previously in a randomized trial comparing three combinations of pegylated IFN-a2b and RBV. Of 1 5 3 0 patients who were enrolled in the treatment trial, 3 5 2 were included in the present study because liver b~opsy specimens and stored serum samples were available (before and 6 months after treatment). The FT and AT test results were compared with the histological findings from liver biopsy specimens. Findings from this study suggest that both biochemical markers have significant predictive ability for the diagnosis of fibrosis and for activity. The FT test in this study was able to distinguish fairly well between fibrosis stages FO-F2 and F3-F4. The area under the receiver operating characteristic (ROC) curves (AUROC) of the FT test for the diagnosis of fibrosis varied between 0.73 and 0.77. The AUROC for the AT test was even higher (0.72-0.86) for the diagnosis of activity (grades A2-3 or A3). These results were the same whether the Metavir or Knodell scoring system were used to grade activity and stage fibrosis. There were significant decreases in FT and AT scores among patients with SVR compared wlth nonresponders (NR) or relapsers corresponding to deceased fibrosis and inflammatory activity in liver biopsy specimens obtained 6 months after discontinuation of therapy. Finally, the authors showed that the AUROC values were significantly higher for the AT test according to the quality of liver biopsy specimens (specimens >15 mm with more than six portal tracts had the hlghest AUROC), suggesting that some of the discordances between biochemical
TLR3 and TLR4 SNP variants in the liver disease resulting from hepatitis B virus and hepatitis C virus infection
Published in British Journal of Biomedical Science, 2019
I Sghaier, S Zidi, L Mouelhi, E Ghazoueni, E Brochot, WY Almawi, BY Loueslati
Demographic, laboratory and clinical characteristics of participants are summarised in Table 1. There was no difference in the sex ratios of the HCV patients, but age increased with liver disease stage. There was also an age difference in the HBV patients, and there were more men with HCC. The differences in Actitest were marginally significant in the HCV group, but in the HBV group, these differences were significant. There were significant differences in Fibrotest results in both groups. AST and ALT differed between HCV patients, but in the HVB patients only the AST levels varied. In both groups, AFP was increased in cirrhosis and increased further in those with HCC.
Chronic hepatitis C: Diagnosis and treatment made easy
Published in European Journal of General Practice, 2022
Naim Abu-Freha, Binil Mathew Jacob, Ali Elhoashla, Zaid Afawi, Talab Abu-Hammad, Foad Elsana, Sergey Paz, Ohad Etzion
Invasive liver biopsy used to be the best option for assessing liver fibrosis in the past; however, nowadays imaging and labs panel testing are available, namely fibroscan and fibrotest. Fibroscan (liver elastography) or fibrotest (calculation of Alpha-2-macroglobulin, Haptoglobin, Apolipoprotein A1, Gamma-glutamyl transpeptidase (GGT), Total bilirubin, and Alanine transaminase) have essentially replaced the liver biopsy for fibrosis assessment testing in chronic HCV patients. Nowadays, biomarkers for fibrosis are recommended, since this testing is simple, inexpensive and readily available. Most common fibrosis panels are FIB-4 and APRI (AST to Platelet Ration Index), which involve calculations of simple, readily available blood tests. FIB-4 test includes calculation of age, AST, ALT and platelets, whereas APRI is an AST to platelets ration index [18]. In case of suspicion of advanced fibrosis, an additional fibrosis assessment is needed (Fibrotest/Fibroscan). FIB-4 < 1.45 has a negative predictive value of 90% for advanced fibrosis [22]. Several scores are used for the histological fibrosis assessment, of which the non-invasive modalities grading scores are comparable with the Metavir score, which is used as scoring for liver biopsy. Five different grades are used, F0 for no fibrosis, F1 for mild fibrosis (fibrous portal expansion), F2 for moderate fibrosis (periportal septae), F3 for severe fibrosis (portal-central septae) and F4 for cirrhosis [23]. Patients with asymptomatic cirrhosis are referred to as having compensated cirrhosis, whereas patients considered to have decompensated cirrhosis are those with development of complications from portal hypertension or liver dysfunction such as ascites, varices bleeding, liver failure, hepato-renal syndrome or encephalopathy.
Indications and methods for measuring portal hypertension in cirrhosis
Published in Scandinavian Journal of Gastroenterology, 2022
Helle Kristensen, Nina Kimer, Søren Møller
A variety of biomarkers are validated for the diagnosis of fibrosis. Both indirect scores with markers of liver function (APRI, Fibrosis-4 (FIB-4), and platelet count) and the direct serum extracellular matrix components and intermediates of fibrogenesis (Enhanced Liver Fibrosis (ELF)-test and FibroTest) [25–27]. Their accuracy is reasonable to distinguish between the absence of or little fibrosis and advanced stages of fibrosis [28,29].