Avaliação da elastografia de quantificação de ponto na predição de fibrose hepática em pacientes com hepatite C
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Data
2021-05-31
Autores
Puatto, Mariana Janas
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Universidade Estadual Paulista (Unesp)
Resumo
A hepatite C é uma doença hepática infecciosa causada pelo vírus da hepatite C (VHC). Estima-se que cerca de 130-150 milhões de pessoas no mundo estejam infectadas, totalizando cerca de 400 mil óbitos por ano. A progressão natural da doença causa fibrose hepática e seu estadiamento é essencial na decisão do tratamento e acompanhamento dos pacientes. O escore mais utilizado para estadiamento de fibrose é a escala METAVIR (F1, F2, F3, F4). A biópsia hepática é a metodologia padrão-ouro, porém, é um procedimento invasivo sujeito a complicações, dor intensa e sangramento. Métodos não invasivos têm sido propostos, sendo a elastografia de quantificação de ponto uma das alternativas, no entanto, na literatura não há intervalos de referência padronizados para classificação dos resultados de elastografia na escala METAVIR. O presente trabalho trata-se de um estudo retrospectivo com o objetivo de avaliar o desempenho da elastografia hepática, utilizando a técnica ElastPQ (aparelho Affiniti 70® da Philips), comparada à biópsia em pacientes VHC+, com o intuito de estabelecer intervalos de referência correspondentes à classificação do grau de fibrose. Foram incluídos 217 pacientes pelos critérios de inclusão: pacientes VHC+ crônicos, submetidos à biópsia e elastografia hepática pré-tratamento, com intervalo máximo de dois anos entre os exames. Critérios de exclusão: coinfecções VHB e/ou HIV, uso de álcool, paciente renal crônico, com CHC ou doenças relacionadas ao fígado, tratamento realizado entre Bx e ELH e falta de dados. O grau de fibrose obtido nas biópsias foi utilizado como padrão, comparando-se aos valores de rigidez hepática (kPa) obtidos na elastografia. A predição dos intervalos de referência foi feita utilizando o algoritmo J48 em uma abordagem de aprendizado de máquina supervisionado. Foi possível estabelecer intervalos de referência para a classificação do grau de fibrose, onde para F0/F1 (≤4,96kPa); F2 (>4,96 a ≤9,2kPa); F3 (>9,2 a ≤12,13kPa); F4 (>12,13kPa). Ao score desenvolvido atribuiu-se o nome ElastScore. Este estudo demonstrou que ElastPQ é método válido e eficiente na medição de fibrose hepática comparado à biópsia, demonstrando adequado desempenho na distinção dos graus de fibrose. Ademais, o ElastScore apresentou desempenho superior quando comparado à performance dos modelos já existentes e em uso para predição não invasiva da fibrose hepática.
Hepatitis C is an infectious liver disease which is caused by the hepatitis C virus (HCV). It is estimated that about 130-150 million people are infected worldwide and it leads to 400 thousand deaths per year. The natural disease progression causes hepatic fibrosis and its staging is essential when it comes to treatment decision and patients’ follow-up. The most commonly used score for fibrosis staging is the METAVIR scoring system (F1, F2, F3, F4). Liver biopsy remains the Gold Standard Methodology even though it is quite an invasive procedure that can cause complications such as severe pain and bleeding. Noninvasive methods have been proposed and point quantification elastography is one of the alternatives but, in literature, there aren’t standardized reference intervals for result evaluation of elastography in the METAVIR scoring system. This paper is all about a retrospective study which aims at evaluating the performance of liver elastography by using the ElastPQ technique (device: Phillips’ Affiniti 70®) when compared to biopsies in HCV+ patients and it also aims at standardizing reference intervals that can correspond to the classification of fibrosis stages. We included 217 patients according to the inclusion criteria: patients with chronic HCV+ who were submitted to biopsy and pretreatment liver elastography, with a maximal time period of two years between the exams. Exclusion criteria: co-infections HBV and/or HIV, alcoholic, chronic renal patient, with HCC or liver-related diseases, treatment performed between Bx and ELH and lack of data. The fibrosis degree that we obtained in the biopsies was used as a standard when compared to the liver stiffness (kPa) values of the elastography. The prediction of reference intervals was carried out with the J48 algorithm in an approach of supervised Machine Learning. It was possible to establish reference intervals for the classification of the fibrosis stage, where for F0/F1 (≤4,96kPa); F2 (>4,96 a ≤9,2kPa); F3 (>9,2 a ≤12,13kPa); F4 (>12,13kPa). That developed score is called ElastScore. This paper demonstrated that ElastScore is a valid and efficient method for liver fibrosis staging when it is compared to biopsies and it is also appropriate to distinguish among different degrees of fibrosis. Moreover, ElastScore showed better performance when compared to other existing models that have been used for a noninvasive prediction of liver fibrosis.
Hepatitis C is an infectious liver disease which is caused by the hepatitis C virus (HCV). It is estimated that about 130-150 million people are infected worldwide and it leads to 400 thousand deaths per year. The natural disease progression causes hepatic fibrosis and its staging is essential when it comes to treatment decision and patients’ follow-up. The most commonly used score for fibrosis staging is the METAVIR scoring system (F1, F2, F3, F4). Liver biopsy remains the Gold Standard Methodology even though it is quite an invasive procedure that can cause complications such as severe pain and bleeding. Noninvasive methods have been proposed and point quantification elastography is one of the alternatives but, in literature, there aren’t standardized reference intervals for result evaluation of elastography in the METAVIR scoring system. This paper is all about a retrospective study which aims at evaluating the performance of liver elastography by using the ElastPQ technique (device: Phillips’ Affiniti 70®) when compared to biopsies in HCV+ patients and it also aims at standardizing reference intervals that can correspond to the classification of fibrosis stages. We included 217 patients according to the inclusion criteria: patients with chronic HCV+ who were submitted to biopsy and pretreatment liver elastography, with a maximal time period of two years between the exams. Exclusion criteria: co-infections HBV and/or HIV, alcoholic, chronic renal patient, with HCC or liver-related diseases, treatment performed between Bx and ELH and lack of data. The fibrosis degree that we obtained in the biopsies was used as a standard when compared to the liver stiffness (kPa) values of the elastography. The prediction of reference intervals was carried out with the J48 algorithm in an approach of supervised Machine Learning. It was possible to establish reference intervals for the classification of the fibrosis stage, where for F0/F1 (≤4,96kPa); F2 (>4,96 a ≤9,2kPa); F3 (>9,2 a ≤12,13kPa); F4 (>12,13kPa). That developed score is called ElastScore. This paper demonstrated that ElastScore is a valid and efficient method for liver fibrosis staging when it is compared to biopsies and it is also appropriate to distinguish among different degrees of fibrosis. Moreover, ElastScore showed better performance when compared to other existing models that have been used for a noninvasive prediction of liver fibrosis.
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Palavras-chave
Hepatite C, Biópsia hepática, Elastografia hepática, Fibrose hepática, Hepatitis C, Liver biopsy, Elastography, Liver fibrosis