Agreement between Results of Shear Wave Elastography of the Liver and Serological Findings for Direct Acting Antivirals in Chronic Hepatic C Infection Treatment Guideline
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Abstract
Hepatitis C infection has the potential to trigger liver fibrosis progression, significantly impacting patient management decisions. However, the traditional gold standard for diagnosis, liver biopsy, is limited by inherent constraints. Consequently, alternative methods, such as serology-based assessments and ultrasound, have been proposed. The serology methods encompass Aspartate aminotransferase (AST) to platelet index (APRI) and the Fibrosis index based on the four factors (Fibrosis-4 index; FIB-4), while ultrasound offers an accurate measurement of liver stiffness.
On August 5, 2022, the Thai government gazette introduced new guidelines for the initiation of direct-acting antiviral drugs (DAA regimens) in the treatment of chronic hepatitis C infection, which includes specific criteria. Despite this, limited research exists comparing 2D-SWE and serology methods, especially in the context of applying the new guidelines. Consequently, the relationship between these diagnostic approaches remains unexplored, necessitating further investigation to optimize diagnostic and treatment decisions for patients with hepatitis C-related liver fibrosis. The purpose of this study is to assess the agreement between the results obtained from 2D-SWE and serology methods concerning the application of the new guideline criteria. A cross-sectional study of patients with hepatitis C infection in Pranangklao Hospital who were sent to 2D-SWE for liver stiffness evaluation in December 2022- May 2023. Ultrasound findings and serology data were recorded and analyzed for agreement of three methods In this study, 91.8% of the 49 examined patients met the liver stiffness criteria as per the new guidelines. The agreement between 2D-SWE and FIB-4 (75.51%) was notably higher than that between 2D-SWE and APRI (57.14%). Visual appearance of cirrhosis, splenic size, gender, and BMI were identified as significant factors contributing to discordant results between 2D-SWE and FIB-4. Regarding the new guideline criteria, a significant level of agreement has been observed between 2D-SWE and FIB-4, surpassing that seen between 2D-SWE and APRI. Notably, certain factors are associated with false-negative outcomes in both serology methods, such as the visual appearance of cirrhosis and splenic size. Additionally, FIB-4 shows correlations with false-negative results based on specific factors, including female gender and body mass index.
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