THE CORRELATION BETWEEN THE ESTIMATED NON-INVASIVE LIVER FIBROSIS AND VARIOUS CLINICAL, BIOLOGICAL AND IMAGING PARAMETERS IN CHRONIC VIRAL HEPATOPATHY

Abstract

Objectives. Evaluating the correlations between a series of clinical, biological and endoscopic parameters and the degree of hepatic fibrosis as it turns out on Fibroma/Fibro scan, with the purpose of establishing useful criteria for clinicians. Material and methods. It was used a retrospective randomized study on 132 patients with viral hepatitis in various stages of evolution, from chronic hepatitis with minor clinical and biological changes to advanced hepatic cirrhosis. The fibrosis degree was evaluated with non-invasive tests (Fibroma/Fibro scan), using for uniformisation and standardization the METAVIR score, and regarding the endoscopic criteria of portal hypertension, the patients were classified in 5 categories – without varices; small, medium or large varices; portal hypertensive gastropathy. Results. The predominant viral etiology within the lot was VHC (75,76%) and the patients with concomitant infection VHB+VHD having the maximum degree of fibrosis (F4) at non-invasive determinations. The proportion of advanced fibrosis (F4) cases was observed at the age category 41-62 with an equal distribution regardless of the patients gender. The patients with severe thrombocytopenia (97,43%) had a maximum degree of fibrosis at non-invasive determinations, and almost 97% of the patients with endoscopic changes had F3 or F4 on Fibromax/Fibroscan. Discussions. The limits of this study were the impossibility of follow-up in dynamics of the correlation between the degree of hepatic fibrosis estimated by Fibromax/Fibroscan and the parameters taken into account (being a retrospective study), the lack of witness lot, relatively small dimensions of the lot and the uneven distribution of the cases with clear dominance of advanced fibrosis. Conclusions. Some biological and imagistic parameters correlate significantly with the result of the non-invasive estimates of the fibrosis degree. Of them, thrombocytopenia is a statistically significant marker, and the endoscopic criteria suggestive for portal hypertension suggest an advanced degree of hepatic fibrosis. The combined use of this factors within a score-system could increase the accuracy of the estimated fibrosis before the specific tests are done.

Keywords

• chronic viral hepatitis
• hepatic fibrosis
• fibroscan
• fibroma
• upper digestive endoscopy
• thrombocytopenia