Noninvasive Marker, Fibrospect II, Overestimates Fibrosis in Hepatitis C-Infected Patients with Chronic Renal Insufficiency

Corresponding Author: Helen S Te, Department of Internal Medicine, University of Chicago Medicine, Section of Gastroenterology, Hepatology and Nutrition, Chicago, Tel: (773) 834 1288; Email:[email protected]

Received Date: 12 Jul 2016  
Accepted Date: 08 Aug 2016  
Published Date: 12 Aug 2016

Copyright © 2016 Te SH

Citation: Rubin JN, Sharabash NM, Cao D, Hammes MS, et al. (2016). Noninvasive Marker, Fibrospect II, Overestimates Fibrosis in Hepatitis C-Infected Patients with Chronic Renal Insufficiency. Mathews J Gastroenterol Hepatol 1(1):002.

ABSTRACT

Aim: Liver biopsy is the gold standard for determining liver fibrosis stage, but it is an invasive test with fallibility including sampling error and observer variability. Many non-invasive markers including Fibrospect II, a proprietary formula, have been developed to replace liver biopsy, but their accuracy in patients with chronic renal insufficiency (CRI) is unclear. We aimed to investigate the accuracy of Fibrospect II in chronic hepatitis C (HCV) infected patients with CRI.

Methods:Liver biopsies and serum Fibrospect II scores of 20 patients with HCV and CRI (HCV+CRI) defined as glomerular filtration rate (GFR) < 55 ml/min were compared to 18 patients with HCV infection and normal renal function (GFR =55 ml/ min (HCV). Ten non-HCV infected hemodialysis (HD) patients also had Fibrospect II scores drawn before and after a HD session.

Results: The HCV+CRI cohort had a higher mean Fibrospect II score of 92.5±10.2 than the HCV (58.5±27.7) and hemodialysis (68.7±28.0) groups (p = 0.0001). Fibrospect II scores correlated poorly with the histologic fibrosis stage in the HCV+CRI cohort, with an area under the receiver operator curve (AUROC) of 0.48, while the HCV group had a good AUROC of 0.89. In the HD patients, Fibrospect II scores decreased following a hemodialysis session 68.7 to 58.4, but this was not statistically significant (p = 0.3).

Conclusion: While Fibrospect II is a useful noninvasive tool to stage fibrosis in HCV infection, it overestimates the amount of liver fibrosis in patients with CRI, thereby limiting its utility in this population.

ABBREVIATIONS A2M: Alpha-2 macroglobulin
ALT: Alanine aminotransferase
APRI: Aspartate aminotransferase to platelet ratio
AST: Aspartate aminotransferase
AUROC: Area under receiver operating characteristic
CI: Confidence Interval
COMP: Cartilage oligomeric matrix protein
CRI: Chronic renal insufficiency
GFR: Glomerular Filtration Rate
GGT: Gamma-glutamyl-transpeptidase
HA: Hyaluronic acid
HBV: Hepatitis B virus
HCV: Hepatitis C virus
HIV: Human immunodeficiency virus
HD: Hemodialysis
NAFLD: Non-alcoholic fatty liver disease
NPV: Negative Predictive Value
PPV: Positive Predictive Value
TE: Transient Elastography
TIMP-1: Tissue inhibitor of metalloproteinase-1