Indirect Serum Fibrosis Markers in Hepatitis C Virus (HCV) Infection
Karolina Paunovic, Miomir Stojanovic, Zorica Dimitrijevic, Goran Paunovic, Vidojko Djordjevic, Ljiljana Konstantinovic, Svetislav Kostic
Med Arh. 2012; 66(4): 226-230

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Assessment of liver fibrosis is important for making treatment decisions, as well as for predicting prognosis and therapeutic outcome in patients on chronic hemodialysis (HD) treatment and infected with hepatitis C virus (HCV). The aim of the present investigation was to evaluate changes in standard laboratory tests (AST, ALT, γGT, cholesterol and platelet count) and indirect serum fibrosis markers: AST-to-platelet ratio index (APRI), FIB-4 and Forns index, in chronically HCV-infected patients on maintenance HD with and without antiviral treatment. Patients and methods: A total of 38 patients on chronic HD program more than 3 months and with chronic hepatitis C, were included in the study. According to local legislature 14 patients receive antiviral therapy (24 or 48 weeks, according to HCV genotype) adjusted for patients on HD: eight of them achieved sustained virological response (SVR) and six did not. Results: All treated patients were HCV genotype 1. Baseline blood samples for standard laboratory tests and indirect serum fibrosis markers were collected on the day of antiviral treatment initiation, as well as at the end of follow-up treatment, 36 month later. At the beginning of antiviral treatment there were no significant differences in APRI, FIB-4, Forns and its components be-tween patients who will achieve SVR and those who did not. A significant decrease of AST, ALT, γGT and APRI, and moderate decrease FIB-4 and Forns index was found at the end of follow-up in patients with SVR. In non-sustained responders group those three indexes and its components remained unchanged. Using cut-of values for APRI and FIB-4 (APRI<0,5 and FIB-4<1,45) it was registered that raised percentage of patients with “no fibrosis” at the end of follow-up in those who achieved SVR. Absence of fibrosis measured by Forns index remained unchanged in all groups of patients. Conclusion: Simple indexes as APRI and FIB-4, successfully decrease after antiviral treatment of chronic hepatitis C in hemodialysis patients. These parameters seems to be useful in monitoring for liver fibrosis rate after antiviral treatment in patients on maintenance HD infected by HCV and can be used for estimation liver fibrosis progression in candidates for cadaveric renal transplantation.


1. Ahmad W, Ijaz B, Gull S, Asad S, Khaliq S, Jahan S, Sarwar MT, Kausar H, Sumrin A, Shahid I, Hassan S: A brief review on molecular, genetic and imaging techniques for HCV fibrosis evaluation. Virol J 2011, 8:53.

2. Alavian SM. A shield against a monster: Hepatitis C in hemodialysis patients. World J Gastroenterol 2009; 15: 641-46.

3. Alavian SM, Hosseini-Moghaddam SM, Rahnavardi M. Hepatitis C among hemodialysis patients: a review on epidemiologic, diagnostic, and therapeutic features. Hep Mon 2007; 7: 153-62.

4. Liu CH, Kao JH. Treatment of hepatitis C virus infection in patients with end-stage renal disease. J Gastroenterol Hepatol 2011; 26: 228-39.

5. Fabrizi F, Messa P, Martin P. Transmission of hepatitis C virus infection in hemodialysis: current concepts. Int J Artif Org 2008; 31: 1004-16.

6. Liu CH, Liang CC, Liu CJ, Lin JW, Chen SI, Hung PH, Tsai HB, Lai MY, Chen PJ, Chen DS, Kao JH. Pegylated interferon alfa-2a monotherapy for hemodialysis patients with acute hepatitis C. Clin Infect Dis 2010; 51:541-49.

7. Butt AA, Khan UA, Skanderson M. Comorbidities and their impact on mortality in HCV and HCV-HIV coinfected persons on dialysis. J Clin Gastroenterol 2008; 42: 1054-59.

8. Butt AA, Skanderson M, McGinnis KA, Ahuja T, Bryce CL, Barnato AE, Chang CCH. Impact of hepatitis C virus infection and other comorbidities on survival in patients on dialysis. J Viral Hepat 2007; 14: 688-96.

9. Fabrizi F, Messa P, Martin P. Health-related quality of life in dialysis patients with HCV infection. Int J Artif Org 2009; 32: 473-81.

10. Martinez SM, Fernandez-Varo G, Gonzales P, Sampson E, Bruguera M, Navasa M, Jimenez W, Sanchez-Tapias JM, Forns X. Assessment of liver fibrosis before and after antiviral therapy by different serum marker panels in patients with chronic hepatitis C. Aliment Pharmacol Ther 2011; 33:138-48.

11. Sebastiani G, Gkouvatsos K, Plebani M. Non-invasive assessment of liver fibrosis: it is time for laboratory medicine. Clin Chem Lab Med 2011; 49:13-32.

12. Forns X, Ampurdanès S, Llovet JM, Aponte J, Quinto L, Martinez-Bauer E, Bruguera M, Sánchez-Tapias JM, Rodés J. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology 2002; 36: 986-92.

13. Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Morrero JA, Conjeevaram HS, Lok ASF. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003; 38: 518-26.

14. Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V, Fontaine H, Pol S. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. Comparison with liver biopsy and Fibro Test. Hepatology 2007, 46:32-6.

15. Domonguez-Gil B, Morales JM. Transplantation in the patient with hepatitis C. Transpl Int 2009; 22: 1117-31.

16. Poynard T, Ngo Y, Munteanu M, Thabut D, Massard J, Moussalli J, Varaud A, Benhamou Y, Ratziu V. Biomarkers of liver injury for hepatitis clinical trials: a meta-analysis of longitudinal studies. Antiviral Therapy 2010; 15: 617-31.

17. Manning DS, Afdhal NH. Diagnosis and quantitation of fibrosis. Gastroenterology 2008; 134:1670-81.

18. Poynard T, Morra R, Ingiliz P, Imbert-Bismut F, Thabut D, Messous D, Munteanu M, Massard J, Benhamou Y, Ratziu V. Biomarkers of liver fibrosis. Adv Clin Chem 2008; 46: 131-60.

19. Schiavon LL, Schiavon JLN, Carvalho-Filho RJ, Sampaio JP, Lanzoni VP, Silva AEB, Ferraz MLG. Simple blood test as noninvasive markers of liver fibrosis in hemodialysis patients with chronic hepatitis C virus infection. Hepatology 2007; 46:307-14.

20. Liu CH, Liang CC, Liu CJ, Hsu SJ, Lin JW, Chen SI, Hung PH, Tsai HB, Lai MY, Chen PJ, Chen JH, Chen DS, Kao JH. The ratio of aminotransferase to platelets is a useful index for predicting hepatic fibrosis in hemodialysis patients with chronic hepatitis C. Kidney Int 2010; 78: 103-9.

21. Canbakan M, Senturk H, Canbakan B, Toptas T, Tabak O, Ozaras R, Tabak F, Balci H, Sut N, Ozbay G. Validaton of biohemical markers for prediction of liver fibrosis and necroinflamatory activity in haemodialysis patients with chronic hepatitis C. Nephron Clin Pract 2011; 117: c289-95.

22. Koda M, Matunaga Y, Kawakami M, Kishimoto Y, Suou T, Murawaki Y. FibroIndex, a practical index for predicting significant fibrosis in patients with chronic hepatitis C. Hepatology 2007; 45: 297-306.

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