Liver US predicts 5-year survival in chronic HBV infection

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Ultrasound exams assessing liver stiffness can help predict survival among patients with chronic hepatitis B (HBV) infection, according to research published April 22 in Alimentary Pharmacology and Therapeutics.

More than 350 million patients around the world are infected with chronic HBV, and accurate evaluation is essential for management and prognosis as well as informing decisions about transplantation.

Liver biopsy is not an ideal option because of complications, expense and patient reluctance. Different scores, such as the Child-Pugh score or MELD, have correlated with prognosis. FibroTest, a noninvasive marker, also is accurate and reproducible in terms of predicting bridging fibrosis and cirrhosis in patients with chronic liver diseases. Previous studies have demonstrated that liver stiffness measurement using ultrasound also has a high degree of accuracy and reproducibility in this population.

However, researchers had not evaluated a relationship between five-year overall survival and liver stiffness in patients with chronic HBV. V. de Ledinghen, MD, from Centre d’Investigation de la Fibrose Hepatique in Hopital Haut-Leveque in Bordeaux, France, and colleagues evaluated these outcomes in a 600-patient, five-year consecutive cohort study that collected data from April 2003 to December 2010.

During the course of the study, 25 patients died and four had liver transplants. Survival was significantly decreased in patients diagnosed with severe fibrosis, according to the researchers. Prognosis worsened as liver stiffness and FibroTest increased.

The five-year overall survival was 97.1 percent in patients with liver stiffness <9 kPa, and 61.5 percent in patients with liver stiffness >20 kPa, according to the researchers. The five-year overall survival was 96.8 percent for FibroTest ≤ 0.73, and 49.2 percent in patients with Fibrotest >0.85. Prognostic performance results were highly significant for both tests without significant differences between the biomarkers.

Both tests also provided better prognostic value for staging than liver biopsy, added de Ledinghen and colleagues.

These data led to de Ledinghen et al to conclude that liver stiffness measurement or FibroTest can predict survival in early chronic HBV. They suggested that physicians adopt these tools to inform early prognosis and treatment planning.

“Liver stiffness, as a good predictive factor of survival, may help the physician to evaluate earlier the severity of those diseases, to decide with stronger arguments of a liver transplantation or a portosystemic shunt, and to evaluate more precisely the surgical risk of our cirrhotic patients.”