Hepascore predictive of mortality, morbidity in chronic HCV

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Chinnaratha MA. Liver Int. 2013;doi:10.1111/liv.12306.

August 20, 2013

Hepascore, a noninvasive measurement of liver fibrosis, was similarly accurate to liver biopsy in predicting mortality and liver-related morbidity among patients with chronic hepatitis C in a recent study.

Researchers evaluated 406 patients with chronic hepatitis C (CHC) during a mean follow-up of 5.9 years. Hepascore, calculated from levels of hyaluronic acid, alpha-2-macroglobulin, bilirubin and gamma glutamyltransferase, was measured in all patients. FIB-4 and aspartate aminotransferase/platelet ratio index (APRI) values were determined in 216 cases, and 148 patients underwent liver biopsy. Patients with Hepascores greater than 0.5 were considered to have significant fibrosis.

Thirty-one percent of patients had significant fibrosis, and 15% had cirrhosis according to Hepascore, compared with 15% and 10%, respectively, according to APRI. Among those who underwent liver biopsy, 49% had significant fibrosis, and 11% had cirrhosis. Hepascore and fibrosis score were significantly correlated among these patients (r=0.53, P<.001).

Twenty-two patients (5.4%) died during follow-up, including 10 from liver-related causes, and four patients who required liver transplantation. Hepascore was predictive of overall survival (HR=24.4; 95% CI, 5.8-102), and significant fibrosis as indicated by Hepascore was associated with liver-related (HR=32.8; 95% CI, 4.3-250) and overall mortality (HR=6.7; 95% CI, 2.6-17.1), while FIB-4 and APRI were not.

AUROC analysis indicated that liver biopsy and Hepascore were similarly predictive of liver-related death (AUROC=0.87; 95% CI, 0.79-0.96 for biopsy; AUROC=0.86; 95% CI, 0.8-0.9 for Hepascore). Investigators said patients with a Hepascore below 0.5 had a 99% probability of no liver-related death within 5 and 10 years.

Liver decompensation occurred in 3.9% of the cohort. Hepascore (HR=27; 95% CI, 5.3-142) and fibrosis stage according to biopsy (HR=3.1; 95% CI, 1.8-5.3) were associated with risk for liver-related morbidity. No association was observed with FIB-4 or APRI.

“Hepascore independently predicted overall and liver-related mortality and liver-related morbidity in patients with CHC and is comparable to liver biopsy,” the researchers concluded. “Hepascore is noninvasive, inexpensive and can be repeated over time to monitor patients. Thus, Hepascore could be incorporated into the management algorithm of CHC patients as a prognostic tool.”

Disclosure: Researchers Gary Jeffrey, Enricco Rossi and Leon Adams are co-proprietors for the Australian Patent for Hepascore. University of Western Australia and PathWest, which employ the researchers, hold a licensing agreement for Hepascore with Quest Diagnostics.

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