Patologìâ (May 2019)
Prognostic model of rapid hepatic fibrosis progression in men with chronic hepatitis C
Abstract
The aim of the research was to determine clinical and genetic predictors and to create a prognostic model for the rapid hepatic fibrosis progression in men with chronic hepatitis C. Materials and methods. А cross-sectional study which included 111 male patients with chronic hepatitis C was conducted. The patient examination program included: assessment of complaints and anamnestic data, physical examination, complete blood count, biochemical test, the stages of hepatic fibrosis according to METAVIR аnd genetic studies (detecting carriers alleles 11Gln or 11Leu of TLR7 gene in the genome of the examined men). Results. It was determined that informative predictors of rapid hepatic fibrosis progression in men with chronic hepatitis C are: ethanol use in a dose of more than 40 g/day (ОR = 2.40, P = 0.042), presence of chronic cholecystitis in past history (ОR = 2.94, P = 0.013), ALT level above 3 upper limit of normal (ОR = 2.49, P = 0.031), the levels of AST, GGT exceeding upper limit of normal (ОR = 6.94, P < 0.001 and ОR = 4.02, P = 0.001 respectively), hyperbilirubinemia (ОR = 3.13, P = 0.010) and carrier state of allele 11Gln of TLR7 gene in the genome (ОR = 3.62, P = 0.036). In order to optimize the prognosis of rapid hepatic fibrosis progression in men with chronic hepatitis C a model that demonstrated statistical significance (χ² = 44.73, P < 0.001) and high operational characteristics (sensitivity – 76.8 %, specificity – 74.5 %, the total number of correct predictions – 75.7 %, AUC of the ROC-curve – 0.828), which indicates the feasibility of its practical use, was proposed. Conclusions. An effective clinical and genetic prognostic model has been created and allows us to predict the probability of rapid hepatic fibrosis progression in men with chronic hepatitis C with high accuracy and to form a group of patients who need high priority antiviral therapy.
Keywords
