Estimating chronic hepatitis C prognosis using transient elastography-based liver stiffness: A systematic review and...

Area of Science:

• Hepatology and Viral Gastroenterology
• Noninvasive Diagnostic Techniques
• Prognostic Biomarkers

Background:

• Chronic hepatitis C (CHC) is a primary driver of liver fibrosis and cirrhosis.
• Histology-based fibrosis progression rates (FPRs) traditionally estimate CHC prognosis.
• Noninvasive methods, like transient elastography (TE) measuring liver stiffness (LSM), are emerging alternatives to liver biopsy.

Purpose of the Study:

• To estimate prognosis in treatment-naïve CHC patients using TE-based liver stiffness progression rates (LSPRs).
• To compare the consistency between LSPRs and FPRs for predicting disease progression.

Main Methods:

• Systematic literature search (January 1990 to February 2016) across multiple databases.
• Calculation of LSPRs using direct (serial LSMs) or indirect (single LSM) methods.
• Random-effects meta-analyses and meta-regression to pool data and explore heterogeneity; FPRs estimated for validation.

Main Results:

• Twenty-seven studies (N=5874) were included; 58% of patients were HIV/HCV-coinfected.
• Estimated time-to-cirrhosis was 39 years for TE-based LSPRs versus 38 years for biopsy-based FPRs.
• Male sex and HIV coinfection positively correlated with LSPRs; age at assessment showed a negative association.

Conclusions:

• Noninvasive prognosis using LSPRs is consistent with FPRs in predicting time-to-cirrhosis in CHC.
• TE-based LSPRs provide a viable alternative to traditional biopsy for prognostic assessment.
• Longitudinal studies focusing on liver stiffness are necessary for more refined prognostic estimates.