Prediction of Hepatic Fibrosis in Patients With Chronic Hepatitis C by Biochemical and Duplex Doppler Indices
Prediction of Hepatic Fibrosis in Patients With Chronic Hepatitis C by Biochemical and Duplex Doppler Indices
The purpose of our prospective study was to evaluate the value of Doppler parameters and
 compare the diagnostic accuracy of Doppler parameters with various biochemical indices in
 predicting significant hepatic fibrosis (≥ F2) and cirrhosis (F4) in chronic hepatitis C
 (CHC) patients.
Chronic hepatitis C virus (HCV) infection is a global health problem, affecting about 3% of
 the world's population. Compared to patients with mild hepatic fibrosis, those with
 significant fibrosis are at risk of developing cirrhosis over a 10- to 20-year period. This
 fact suggests the need of early antiviral therapy in chronic hepatitis C (CHC) patients to
 prevent the development of cirrhosis and associated complications. For patients having
 cirrhosis, surveillance endoscopy and ultrasound for gastroesophageal varices and
 hepatocellular carcinoma are needed to minimize morbidity and mortality ). Furthermore,
 reduced treatment response and tolerability to antiviral therapy may be encountered in
 cirrhotic patients. An accurate assessment of hepatic fibrosis stage is therefore important
 for both diagnostic and therapeutic purposes.

 Liver biopsy has been recognized as the gold standard for assessing the grade of
 necroinflammation and stage of fibrosis. However, it is costly, and harbors risk of
 complications, including 20% of patient discomfort, 0.1-3% of significant morbidity, and
 0.02-0.24% of mortality. In addition, sampling error due to the non-uniform distribution of
 the parenchymal damage, as well as intra- and inter-observer variability is often
 encountered. A noninvasive tool to evaluate liver disease activity or fibrosis stage would be
 helpful, particularly in monitoring CHC patients over time.

 Noninvasive methods to evaluate the hepatic histology in HCV-infected patients include
 symptoms and signs, routine laboratory tests, serum markers of fibrosis and inflammation,
 quantitative tests of liver function, and radiological imaging. Previous studies have
 assessed the usefulness of noninvasive tests in predicting hepatic fibrosis. However, none of
 them showed satisfactory results, either due to lack of accuracy, accessibility,
 reproducibility or being expensive.

 Duplex Doppler ultrasonography (DDU), which is readily available and non-invasive, has been
 used for the assessment of splanchnic vascular hemodynamics in patients with chronic liver
 disease. Portal vein velocity (PVV) has been shown to be correlated with significant fibrosis
 or cirrhosis. Hepatic artery resistive index (HARI) and pulsatility index (HAPI) are
 associated with portal vein resistance and hepatic vein-portal vein pressure gradient (HPVG).
 Splenic artery resistive index (SARI) and pulsatility index (SAPI) are associated with portal
 vein resistance, cirrhosis and grade of esophageal varices (EV). Previous studies to evaluate
 the value of DDU in predicting liver histology are controversial, probably due to small
 patient number, diverse grading of liver histology, and large missing data.

 Thus, the purpose of our prospective study was to evaluate the value of Doppler parameters
 and compare the diagnostic accuracy of Doppler parameters with various biochemical indices in
 predicting significant hepatic fibrosis (≥ F2) and cirrhosis (F4) in chronic hepatitis C
 (CHC) patients.
Inclusion Criteria:

 -  Age older than 18 years

 -  Positive anti-HCV and HCV RNA for more than 6 months

 -  Alanine aminotransferase level more than twice the upper limit of normal (ULN)

 Exclusion Criteria:

 -  HBV and HCV co-infection

 -  HIV and HCV co-infection

 -  Heavy alcohol use (> 50 gram/day)

 -  Autoimmune liver diseases

 -  Metabolic liver diseases

 -  Presence of hepatocellular carcinoma