Non-invasive fibrosis score for hepatitis delta
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Non-invasive fibrosis score for hepatitis delta. / Lutterkort, Gunnar L; Wranke, Anika; Yurdaydin, Cihan; Budde, Eva; Westphal, Max; Lichtinghagen, Ralf; Stift, Judith; Bremer, Birgit; Hardtke, Svenja; Keskin, Onur; Idilman, Ramazan; Koch, Armin; Manns, Michael P; Dienes, Hans P; Wedemeyer, Heiner; Heidrich, Benjamin.
In: LIVER INT, Vol. 37, No. 2, 02.2017, p. 196-204.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Non-invasive fibrosis score for hepatitis delta
AU - Lutterkort, Gunnar L
AU - Wranke, Anika
AU - Yurdaydin, Cihan
AU - Budde, Eva
AU - Westphal, Max
AU - Lichtinghagen, Ralf
AU - Stift, Judith
AU - Bremer, Birgit
AU - Hardtke, Svenja
AU - Keskin, Onur
AU - Idilman, Ramazan
AU - Koch, Armin
AU - Manns, Michael P
AU - Dienes, Hans P
AU - Wedemeyer, Heiner
AU - Heidrich, Benjamin
N1 - © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2017/2
Y1 - 2017/2
N2 - BACKGROUND & AIMS: Identifying advanced fibrosis in chronic hepatitis delta patients and thus in need of urgent treatment is crucial. To avoid liver biopsy, non-invasive fibrosis scores may be helpful but have not been evaluated for chronic hepatitis delta yet.METHODS: We evaluated eight non-invasive fibrosis scores in 100 HDV RNA-positive patients with available central histological reading. New cut-off values were calculated by using Receiver Operating Characteristics and Youden indexes. Predictors for the presence of ISHAK F3-6 were revealed by t-tests or Mann-Whitney tests.RESULTS: None of the tested scores had an area under the curve (AUROC) > 0.8 and performed according to our predefined requirements of a sensitivity of >80% and a positive predictive value (PPV) >90% - even after adaption. However, the ELF score was able to identify advanced fibrosis with a high sensitivity (93%) and PPV (81%), but relies on expensive extracellular matrix markers with bad availability in many endemic regions of HDV. Thus, we developed a novel non-invasive approach and identified low cholinesterase (P=.002), low albumin (P=.041), higher gamma glutamyl transferase, as well as older age (P<.001) as predictors of fibrosis resulting in the Delta Fibrosis Score (DFS). The DFS performed with a sensitivity of 85% and PPV of 93% with an AUROC of 0.87.CONCLUSIONS: Existing non-invasive fibrosis scores are either impracticable or do not perform well in chronic hepatitis delta patients. However, the new Delta Fibrosis Score is the first non-invasive fibrosis score specifically developed for chronic hepatitis delta and requires only standard parameters.
AB - BACKGROUND & AIMS: Identifying advanced fibrosis in chronic hepatitis delta patients and thus in need of urgent treatment is crucial. To avoid liver biopsy, non-invasive fibrosis scores may be helpful but have not been evaluated for chronic hepatitis delta yet.METHODS: We evaluated eight non-invasive fibrosis scores in 100 HDV RNA-positive patients with available central histological reading. New cut-off values were calculated by using Receiver Operating Characteristics and Youden indexes. Predictors for the presence of ISHAK F3-6 were revealed by t-tests or Mann-Whitney tests.RESULTS: None of the tested scores had an area under the curve (AUROC) > 0.8 and performed according to our predefined requirements of a sensitivity of >80% and a positive predictive value (PPV) >90% - even after adaption. However, the ELF score was able to identify advanced fibrosis with a high sensitivity (93%) and PPV (81%), but relies on expensive extracellular matrix markers with bad availability in many endemic regions of HDV. Thus, we developed a novel non-invasive approach and identified low cholinesterase (P=.002), low albumin (P=.041), higher gamma glutamyl transferase, as well as older age (P<.001) as predictors of fibrosis resulting in the Delta Fibrosis Score (DFS). The DFS performed with a sensitivity of 85% and PPV of 93% with an AUROC of 0.87.CONCLUSIONS: Existing non-invasive fibrosis scores are either impracticable or do not perform well in chronic hepatitis delta patients. However, the new Delta Fibrosis Score is the first non-invasive fibrosis score specifically developed for chronic hepatitis delta and requires only standard parameters.
KW - Adult
KW - Biomarkers/blood
KW - Biopsy
KW - Clinical Trials, Phase II as Topic
KW - Disease Progression
KW - Female
KW - Germany
KW - Hepatitis D, Chronic/complications
KW - Hepatitis Delta Virus
KW - Humans
KW - Liver/pathology
KW - Liver Cirrhosis/diagnosis
KW - Male
KW - Middle Aged
KW - Multicenter Studies as Topic
KW - Predictive Value of Tests
KW - ROC Curve
KW - Randomized Controlled Trials as Topic
KW - Severity of Illness Index
KW - Young Adult
KW - gamma-Glutamyltransferase/blood
U2 - 10.1111/liv.13205
DO - 10.1111/liv.13205
M3 - SCORING: Journal article
C2 - 27428078
VL - 37
SP - 196
EP - 204
JO - LIVER INT
JF - LIVER INT
SN - 1478-3223
IS - 2
ER -