Hepatic elastography findings among patients with chronic hepatitis B and C at King Faisal Hospital Rwanda

Hepatic elastography is a reliable, non-invasive imaging technique for assessing liver stiffness, aiding in the diagnosis of liver fibrosis and cirrhosis. Chronic hepatitis B (CHB) and chronic hepatitis C (CHC) contribute significantly to progressive liver disease and hepatocellular carcinoma (HCC) worldwide. Early detection and continuous monitoring of liver stiffness are crucial for effective disease management. However, data on hepatic elastography findings in Rwanda remain limited. This study aimed to describe hepatic elastography findings in patients with CHB and CHC at King Faisal Hospital; describe elastography findings difference in hepatitis B and C and Assess the correlation between demographic and clinical factors and fibrosis severity.

A cross-sectional study was conducted among 149 patients with CHB and CHC. Liver stiffness was assessed using point shear wave elastography (pSWE) on the Siemens Acuson Sequoia ultrasound system. Demographic data, liver function tests, viral loads, and fibrosis staging were collected and analyzed using R and R Studio (v.4.3.3). Descriptive statistics were computed, Fisher's exact test was used to assess associations, and multinomial logistic regression was applied to identify key contributors to fibrosis severity. Model accuracy, sensitivity, and specificity were also evaluated.

Of the 149 participants, 77 (52%) had CHB and 72 (48%) had CHC. Severe fibrosis (F3-F4) was significantly more prevalent in CHC patients (72%) than in CHB patients (28%) (p = 0.011). Age was a strong predictor of fibrosis severity; patients over 40 years were 10.3 times more likely to have advanced fibrosis (p = 0.002). Other significant predictors included patient with longer infection duration (7-12 years), hepatic steatosis, abnormal viral load, and without on antiviral therapy (p < 0.001). Elevated AST, ALT, and GGT were strongly associated with advanced fibrosis (p < 0.001). Sex was not significantly associated with fibrosis severity. Elastography findings correlated well with biopsy results, with 84% of patients classified as F3-F4 by elastography confirmed to have advanced fibrosis by biopsy.

This study confirms that hepatic elastography is a powerful, non-invasive diagnostic tool for assessing liver fibrosis in patients with chronic hepatitis B and C. Advanced fibrosis and cirrhosis were significantly more prevalent among hepatitis C patients. Several clinical and demographic factors including older age, longer infection duration, hepatic steatosis observed on routine abdominal ultrasound, abnormal viral load, and lack of antiviral therapy were strongly associated with increased liver stiffness. Elevated liver enzymes (AST, ALT, GGT) also showed a significant correlation with fibrosis severity. Sex was not found to be a statistically significant predictor of fibrosis stage. These findings reaffirm the clinical reliability of elastography as a practical alternative to biopsy, particularly in resource-limited settings.