Non-invasive fibrosis score for hepatitis delta

作者：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^*

来源：Liver International, 2017, 37(2): 196-204.

DOI：10.1111/liv.13205

• hepatitis D virus
• Hepatitis Delta
• liver biopsy
• non-invasive fibrosis
• cirrhosis score

Background & AimsIdentifying 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.
MethodsWe 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.
ResultsNone 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.
ConclusionsExisting 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.

• 出版日期2017-2