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Non‐invasive fibrosis score for hepatitis delta
Author(s) -
Lutterkort Gunnar L.,
Wranke Anika,
Yurdaydin Cihan,
Budde Eva,
Westphal Max,
Lichtinghagen Ralf,
Stift Judith,
Bremer Birgit,
Hardtke Svenja,
Keskin Onur,
Idilman Ramazan,
Koch Armin,
Manns Michael P.,
Dienes Hans P.,
Wedemeyer Heiner,
Heidrich Benjamin
Publication year - 2017
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13205
Subject(s) - fibrosis , medicine , receiver operating characteristic , gastroenterology , chronic hepatitis , hepatitis d , liver biopsy , hepatic fibrosis , hepatitis b , biopsy , hepatitis b virus , immunology , virus , hbsag
Background & Aims Identifying advanced fibrosis in chronic hepatitis delta patients and thus in need of urgent treatment is crucial. To avoid liver biopsy, non‐invasive fibrosis scores may be helpful but have not been evaluated for chronic hepatitis delta yet. Methods We evaluated eight non‐invasive fibrosis scores in 100 HDV RNA‐positive patients with available central histological reading. New cut‐off values were calculated by using Receiver Operating Characteristics and Youden indexes. Predictors for the presence of ISHAK F3‐6 were revealed by t ‐tests or Mann–Whitney tests. Results None of the tested scores had an area under the curve (AUROC) > 0.8 and performed according to our predefined requirements of a sensitivity of >80% and a positive predictive value (PPV) >90% – even after adaption. However, the ELF score was able to identify advanced fibrosis with a high sensitivity (93%) and PPV (81%), but relies on expensive extracellular matrix markers with bad availability in many endemic regions of HDV. Thus, we developed a novel non‐invasive approach and identified low cholinesterase ( P =.002), low albumin ( P =.041), higher gamma glutamyl transferase, as well as older age ( P <.001) as predictors of fibrosis resulting in the Delta Fibrosis Score (DFS). The DFS performed with a sensitivity of 85% and PPV of 93% with an AUROC of 0.87. Conclusions Existing non‐invasive fibrosis scores are either impracticable or do not perform well in chronic hepatitis delta patients. However, the new Delta Fibrosis Score is the first non‐invasive fibrosis score specifically developed for chronic hepatitis delta and requires only standard parameters.