Harun ERDAL, Ayfer BAKIR, Mustafa GÜNEY, Armağan GÜNAL, Cemal Nuri ERÇİN, Ahmet UYGUN, Mustafa GÜLŞEN

Hepatit C enfeksiyonunda karaciğer histopatolojik evreleri ile albümin-bilirübin skoru arasındaki ilişki

Giriş ve Amaç: Karaciğer fibrozunu değerlendirmek için birçok invaziv olmayan biyokimyasal indeksler geliştirilmiştir. Bu çalışmada allbümin-bilirübin skorunun kronik hepatit C virüs enfeksiyonunda gelişen karaciğer fibrozunun tahmininde karaciğer biyopsisine alternatif bir tanı yöntemi olup olamayacağının değerlendirilmesi ve diğer biyokimyasal belirteçler olan fibrozis-4 ve aspartat aminotransferaz/trombosit oran indeksi ile karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Yaş aralığı 20 ile 82 arasında değişen, karaciğer biyopsisi yapılmış, 27’si erkek ve 11’i kadın toplam 38 kronik hepatit C virüs enfeksiyonlu hasta değerlendirildi. Albümin- bilirübin, fibrozis-4 ve aspartat aminotransferaz/trombosit oran indeks skorları hesaplandı. Albümin-bilirübin skorunun fibrozis evre >2 ve ≥4’ü ayırt etme yeteneği ROC analizi ile değerlendirildi ve fibrozis-4 ve aspartat aminotransferaz/trombosit oran indeks skoru ile karşılaştırıldı. Bulgular: Albümin-bilirübin skorunun fibrozis evre >2 ve fibrozis evre ≥4 tanısı için ROC eğrisi altında kalan alan sırasıyla 0.767 (95% Cl: 0.564-0.969) ve 0.956 (95% Cl: 0.889-1.000) bulunurken, fibrozis-4 için 0.863 (95% Cl: 0.714-1.000) ve 0.926 (95% Cl: 0.833-1.000), aspartat aminotransferaz/ trombosit oran indeks skoru için 0.667 (95% Cl: 0.450-0.884) ve 0.640 (95% Cl: 0.378-0.901) idi. Sonuç: Bulgulara göre albümin-bilirübin skorunun fibrozis evre >2 ve ileri karaciğer fibrozunu (fibrozis evre ≥4) tahmin edebileceği değerlendirilmiştir. Albümin-bilirübin skorunun fibrozis tahminindeki performansı, aspartat aminotransferaz/ trombosit oran indeks skoru ve fibrozis-4 ile karşılaştırıldığında sonuçların benzer olduğu ancak fibrozis evre >2 tahmininde fibrozis-4’ün, fibrozis evre ≥4’de ise aspartat aminotransferaz/ trombosit oran indeks skorunun daha güvenilir sonuç verdiği değerlendirilmiştir.

The relationship between histopathological stages of liver fibrosis and albumin–bilirubin score in chronic hepatitis C infection

Background and Aims: Many noninvasive biochemical indices have been developed to evaluate liver fibrosis. This study aimed to evaluate whether albumin–bilirubin score might be used as an alternative diagnostic method to performing liver biopsy to help predict liver fibrosis developing in patients with chronic hepatitis C virus infection and compare the score with other biochemical markers, for example, fibrosis-4 and aspartate aminotransferase-to-platelet ratio index (APRI) scores. Material and Methods: A total of 38 patients between the ages of 20 and 82 who had chronic hepatitis C virus infection and who underwent liver biopsy were evaluated. The patients were 27 males and 11 females. Albumin– bilirubin score, fibrosis-4, and aspartate aminotransferase-to-platelet ratio index score were calculated. Whether albumin–bilirubin score could differentiate fibrosis stage >2 from fibrosis stage ≥4 was evaluated by ROC analysis, and the score was compared with fibrosis-4 and aspartate aminotransferase-to-platelet ratio index scores. Results: The areas under the ROC curve for predicting fibrosis stage >2 and advanced liver fibrosis (fibrosis stage ≥4) according to the albumin–bilirubin score were 0.767 (95% Cl: 0.564–0.969) and 0.956 (95% Cl: 0.889–1.000), respectively, while they were 0.863 (95% Cl: 0.714–1.000) and 0.926 (95% Cl: 0.833–1.000) according to fibrosis-4 score and 0.667 (95% Cl: 0.450–0.884) and 0.640 (95% Cl: 0.378–0.901) according to aspartate aminotransferase-to-platelet ratio index score. Conclusions: According to the findings, it was concluded that albumin–bilirubin score could predict fibrosis stage >2 and advanced liver fibrosis (fibrosis stage ≥4). When the performance of albumin–bilirubin score in the prediction of fibrosis was compared with that of aspartate aminotransferase-to-platelet ratio index index and fibrosis-4 scores, the results were similar. However, fibrosis-4 score gave more reliable results in the prediction of fibrosis stage >2, while albumin–bilirubin score gave more reliable results in the prediction of advanced liver fibrosis (fibrosis stage ≥4).

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