Non Invasive Assessment of Liver Fibrosis in Chronic Liver Disease

Abstract

Background: Chronic hepatitis C (CHC) infection leads to necroinflammation which causes
fibrosis and ultimately cirrhosis in 20% of cases. Liver biopsy is recommended for assessment of
hepatic fibrosis and is thought to be the gold standard. Recurrent bouts of hepatocellular necrosis
in CHC infection cause episodic rise in aminotransferases especially alanine aminotransferase
(ALT). ALT levels decrease as fibrosis advances and AST levels tend to exceed ALT. This results
in increase in AST/ALT ratio >1.0, which can be used as non-invasive marker of hepatic fibrosis
and cirrhosis, thus reducing the number of liver biopsies performed in patients with AST/ALT ratio
>1.0.
Objectives: To assess the accuracy of serum aminotransferases (AST/ALT) ratio for
determining the severity of hepatic fibrosis in patients with chronic hepatitis C, considering
histopathological findings as gold standard.
Study Design: Cross sectional survey.
Setting: Medical unit 4, Services Institute of Medical Sciences (SIMS)/ Services Hospital,
Lahore.
Duration: The study was completed over a period of 6 months; from 15th October, 2008 to 15th
April, 2009.
Subject and Methods: Seventy HCV positive with detectable RNA by Polymerase Chain
Reaction, fulfilling the criteria were selected. AST and ALT levels were measured in (IU/L). Upper
limit of both ASTand ALT was taken as 40 IU/L. AST/ALTratio was calculated as under;
AAR = AST (IU/L), ALT (IU/L) All these patients also underwent percutaneous liver biopsies and
then histopathologist staged biopsy for fibrosis according to Ishak/ Knodell criteria.
Results: AST/ALTratio of more than 1.0 was associated with severe fibrosis/ cirrhosis (F4- f6).
Conclusion: Study showed that AAR more than 1.0 has significant association with severe
fibrosis and identifies CHC patients with marked fibrosis/ cirrhosis, and its application can
decrease the need for performing liver biopsies for staging.