Información del artículo
Resumen
La evaluación de la fibrosis hepática es esencial en los pacientes con hepatitis crónica C, ya que de su gravedad depende su pronóstico y la indicación de tratamiento antiviral. La combinación de marcadores serológicos de fibrosis en algoritmos o scores permite distinguir a un importante número de pacientes con fibrosis significativa y a la mayoría de pacientes con cirrosis hepática, evitando potencialmente un gran número de biopsias. Si bien la interpretación de estos algoritmos debe realizarse teniendo en cuenta sus posibles limitaciones, su alta reproducibilidad, aplicabilidad y disponibilidad hacen que sean métodos esenciales en la evaluación actual de los pacientes con hepatitis crónica C. En la recurrencia de la hepatitis C tras el trasplante hepático, los marcadores serológicos han mostrado una menor capacidad de diagnosticar la presencia de fibrosis. Sin embargo, un algoritmo de marcadores directos ha demostrado tener una excelente capacidad predictiva en pacientes con hepatitis C postrasplante hepático, lo cual lo convierte en una excelente herramienta para establecer el pronóstico de los pacientes e indicar el tratamiento antiviral.
Palabras clave:
ELF
APRI
Forns
FibroTest
Fibrosis significativa
Cirrosis
Abstract
Liver fibrosis must be evaluated in patients with chronic hepatitis C, since its severity will affect prognosis and the indication of antiviral therapy. Combining serological markers of fibrosis in algorithms or scores can identify a substantial number of patients with significant fibrosis and most patients with liver cirrhosis, thus potentially avoiding a large number of biopsies. Although these algorithms should be interpreted with caution, due to their possible limitations, their high reproducibility, applicability and availability make them an essential tool in the current evaluation of patients with chronic hepatitis C infection. In contrast, serological markers have been found to be less effective in the diagnosis of fibrosis in the context of recurrent hepatitis C infection after liver transplantation. However, an algorithm for direct markers has shown excellent predictive ability in liver transplant recipients with hepatitis C. Consequently, this algorithm seems to be an excellent tool to establish prognosis and indicate antiviral therapy.
Keywords:
ELF
APRI
Forns
FibroTest
Significant fibrosis
Cirrhosis
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Bibliografía
[1.]
S.M. Martínez, G. Crespo, M. Navasa, X. Forns.
Noninvasive assessment of liver fibrosis.
Hepatology, 53 (2011), pp. 325-335
[2.]
European Association for the Study of the Liver.
EASL Clinical Practice Guidelines: management of hepatitis C virus infection.
J Hepatol, 55 (2011), pp. 245-264
[3.]
P. Bedossa, D. Dargere, V. Paradis.
Sampling variability of liver fibrosis in chronic hepatitis C.
Hepatology, 38 (2003), pp. 1449-1457
[4.]
X. Forns, S. Ampurdanes, J.M. Llovet, J. Aponte, L. Quinto, E. Martínez-Bauer, et al.
Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model.
Hepatology, 36 (2002), pp. 986-992
[5.]
C.T. Wai, J.K. Greenson, R.J. Fontana, J.D. Kalbfleisch, J.A. Marrero, H.S. Conjeevaram, et al.
A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C.
Hepatology, 38 (2003), pp. 518-526
[6.]
F. Imbert-Bismut, V. Ratziu, L. Pieroni, F. Charlotte, Y. Benhamou, T. Poynard, MULTIVIRC Group.
Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study.
Lancet, 357 (2001), pp. 1069-1075
[7.]
W.M. Rosenberg, M. Voelker, R. Thiel, M. Becka, A. Burt, D. Schuppan, European Liver Fibrosis Group, et al.
Serum markers detect the presence of liver fibrosis: a cohort study.
Gastroenterology, 127 (2004), pp. 1704-1713
[8.]
Z.H. Lin, Y.N. Xin, Q.J. Dong, Q. Wang, X.J. Jiang, S.H. Zhan, et al.
Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis.
Hepatology, 53 (2011), pp. 726-736
[9.]
T. Poynard, R. Morra, P. Halfon, L. Castera, V. Ratziu, F. Imbert-Bismut, et al.
Meta-analyses of FibroTest diagnostic value in chronic liver disease.
BMC Gastroenterol, 7 (2007), pp. 40
[10.]
I.N. Guha, J. Parkes, P. Roderick, D. Chattopadhyay, R. Cross, S. Harris, et al.
Noninvasive markers of fibrosis in nonalcoholic fatty liver disease: Validating the European Liver Fibrosis Panel and exploring simple markers.
Hepatology, 47 (2008), pp. 455-460
[11.]
J. Parkes, I.N. Guha, P. Roderick, S. Harris, R. Cross, M.M. Manos, et al.
Enhanced Liver Fibrosis (ELF.test accurately identifies liver fibrosis in patients with chronic hepatitis C.
J Viral Hepat, 18 (2011), pp. 23-31
[12.]
J. Guechot, C. Trocme, J.C. Renversez, N. Sturm, J.P. Zarski, A.N.R.S. HC, EP 23 Fibrostar Study Group.
Independent validation of the Enhanced Liver Fibrosis (ELF) score in the ANRS HC EP 23 Fibrostar cohort of patients with chronic hepatitis C.
Clin Chem Lab Med, 50 (2012), pp. 693-699
[13.]
L. Castera.
Noninvasive methods to assess liver disease in patients with hepatitis B or C.
Gastroenterology, 142 (2012), pp. 1293-1302
[14.]
G. Sebastiani, P. Halfon, L. Castera, S. Pol, D.L. Thomas, A. Mangia, et al.
SAFE biopsy: a validated method for large-scale staging of liver fibrosis in chronic hepatitis C.
Hepatology, 49 (2009), pp. 1821-1827
[15.]
M. Bourliere, G. Penaranda, C. Renou, D. Botta-Fridlund, A. Tran, I. Portal, et al.
Validation and comparison of indexes for fibrosis and cirrhosis prediction in chronic hepatitis C patients: proposal for a pragmatic approach classification without liver biopsies.
J Viral Hepat, 13 (2006), pp. 659-670
[16.]
V. Leroy, M.N. Hilleret, N. Sturm, C. Trocme, J.C. Renversez, P. Faure, et al.
Prospective comparison of six non-invasive scores for the diagnosis of liver fibrosis in chronic hepatitis C.
J Hepatol, 46 (2007), pp. 775-782
[17.]
J. Boursier, V. De Ledinghen, J.P. Zarski, M.C. Rousselet, N. Sturm, J. Foucher, et al.
A new combination of blood test and fibroscan for accurate non-invasive diagnosis of liver fibrosis stages in chronic hepatitis C.
Am J Gastroenterol, 106 (2011), pp. 1255-1263
[18.]
J. Boursier, J. Vergniol, A. Sawadogo, T. Dakka, S. Michalak, Y. Gallois, et al.
The combination of a blood test and FibroScan improves the non-invasive diagnosis of liver fibrosis.
Liver Int, 29 (2009), pp. 1507-1515
[19.]
L. Castera, J. Vergniol, J. Foucher, B. Le Bail, E. Chanteloup, M. Haaser, et al.
Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C.
Gastroenterology, 128 (2005), pp. 343-350
[20.]
L. Castera, G. Sebastiani, B. Le Bail, V. De Ledinghen, P. Couzigou, A. Alberti.
Prospective comparison of two algorithms combining non-invasive methods for staging liver fibrosis in chronic hepatitis C.
J Hepatol, 522 (2010), pp. 191-198
[21.]
G. Crespo, G. Fernández-Varo, Z. Marino, G. Casals, R. Miquel, S.M. Martínez, et al.
ARFI, FibroScan, ELF, and their combinations in the assessment of liver fibrosis: a prospective study.
J Hepatol, 57 (2012), pp. 281-287
[22.]
S. Benlloch, M. Berenguer, M. Prieto, J.M. Rayon, V. Aguilera, J. Berenguer.
Prediction of fibrosis in HCV-infected liver transplant recipients with a simple noninvasive index.
Liver Transpl, 11 (2005), pp. 456-462
[23.]
S. Benlloch, L. Heredia, C. Barquero, J.M. Rayon, R. Pina, V. Aguilera, et al.
Prospective validation of a noninvasive index for predicting liver fibrosis in hepatitis C virus-infected liver transplant recipients.
Liver Transpl, 15 (2009), pp. 1798-1807
[24.]
P. Toniutto, C. Fabris, D. Bitetto, E. Falleti, C. Avellini, E. Rossi, et al.
Role of AST to platelet ratio index in the detection of liver fibrosis in patients with recurrent hepatitis C after liver transplantation.
J Gastroenterol Hepatol, 22 (2007), pp. 1904-1908
[25.]
T.J. Cross, V. Calvaruso, M.R. Foxton, P. Manousou, A. Quaglia, F. Grillo, et al.
A simple, noninvasive test for the diagnosis of liver fibrosis in patients with hepatitis C recurrence after liver transplantation.
J Viral Hepat, 17 (2010), pp. 640-649
[26.]
J.A. Carrión, G. Fernández-Varo, M. Bruguera, J.C. García-Pagan, J.C. García-Valdecasas, S. Pérez-del-Pulgar, et al.
Serum fibrosis markers identify patients with mild and progressive hepatitis C recurrence after liver transplantation.
Gastroenterology, 138 (2010), pp. 147-158
[27.]
A. Blasco, X. Forns, J.A. Carrión, J.C. García-Pagan, R. Gilabert, A. Rimola, et al.
Hepatic venous pressure gradient identifies patients at risk of severe hepatitis C recurrence after liver transplantation.
Hepatology, 43 (2006), pp. 492-499
[28.]
M. Friedrich-Rust, M.F. Ong, S. Martens, C. Sarrazin, J. Bojunga, S. Zeuzem, et al.
Performance of transient elastography for the staging of liver fibrosis: a meta-analysis.
Gastroenterology, 134 (2008), pp. 960-974
[29.]
J.A. Carrión, M. Navasa, J. Bosch, M. Bruguera, R. Gilabert, X. Forns.
Transient elastography for diagnosis of advanced fibrosis and portal hypertension in patients with hepatitis C recurrence after liver transplantation.
Liver Transpl, 12 (2006), pp. 1791-1798
[30.]
N. Harada, Y. Soejima, A. Taketomi, T. Yoshizumi, T. Ikegami, Y. Yamashita, et al.
Assessment of graft fibrosis by transient elastography in patients with recurrent hepatitis C after living donor liver transplantation.
Transplantation, 85 (2008), pp. 69-74
[31.]
F. Corradi, F. Piscaglia, S. Flori, A. D’Errico-Grigioni, F. Vasuri, M.R. Tame, Bologna Liver Transplantation Group, et al.
Assessment of liver fibrosis in transplant recipients with recurrent HCV infection: usefulness of transient elastography.
Dig Liver Dis, 41 (2009), pp. 217-225
[32.]
R. Masuzaki, N. Yamashiki, Y. Sugawara, H. Yoshida, R. Tateishi, S. Tamura, et al.
Assessment of liver stiffness in patients after living donor liver transplantation by transient elastography.
Scand J Gastroenterol, 44 (2009), pp. 1115-1120
[33.]
S. Beckebaum, S. Iacob, C.G. Klein, A. Dechene, J. Varghese, H.A. Baba, et al.
Assessment of allograft fibrosis by transient elastography and noninvasive biomarker scoring systems in liver transplant patients.
Transplantation, 89 (2010), pp. 983-993
[34.]
C. Kamphues, K. Lotz, C. Rocken, T. Berg, D. Eurich, J. Pratschke, et al.
Chances and limitations of non-invasive tests in the assessment of liver fibrosis in liver transplant patients.
Clin Transplant, 24 (2010), pp. 652-659
[35.]
M. Prieto, M. Berenguer, J.M. Rayón, J. Córdoba, L. Arguello, D. Carrasco, et al.
High incidence of allograft cirrhosis in hepatitis C virus genotype 1b infection following transplantation: relationship with rejection episodes.
Hepatology, 29 (1999), pp. 250-256
[36.]
J.A. Carrión, F. Torres, G. Crespo, R. Miquel, J.C. García-Valdecasas, M. Navasa, et al.
Liver stiffness identifies two different patterns of fibrosis progression in patients with hepatitis C virus recurrence after liver transplantation.
Hepatology, 51 (2010), pp. 23-34
[37.]
C. Rigamonti, M.F. Donato, M. Fraquelli, F. Agnelli, G. Ronchi, G. Casazza, et al.
Transient elastography predicts fibrosis progression in patients with recurrent hepatitis C after liver transplantation.
Gut, 57 (2008), pp. 821-827
[38.]
S. Pungpapong, D.P. Nunes, M. Krishna, R. Nakhleh, K. Chambers, M. Ghabril, et al.
Serum fibrosis markers can predict rapid fibrosis progression after liver transplantation for hepatitis C.
Liver Transpl, 14 (2008), pp. 1294-1302
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