Diagnostic non-invasive model of large risky esophageal varices in cirrhotic hepatitis C virus patients

AIM To build a diagnostic non-invasive model for screening of large varices in cirrhotic hepatitis C virus(HCV) patients. METHODS This study was conducted on 124 post-HCV cirrhotic patients presenting to the clinics of the Endemic Medicine Department at Mansoura University Hospital for evaluation before HCV antiviral therapy: 78 were Child A and 46 were Child B(score ≤ 8). Inclusion criteria for patients enrolled in this study was presence of cirrhotic HCV(diagnosed by either biopsy or fulfillment of clinical basis). Exclusion criteria consisted of patients with other etiologies of liver cirrhosis, e.g., hepatitis B virus and patients with high MELD score on transplant list. All patients were subjected to full medical record, full basic investigations, endoscopy, and computed tomography(CT), and then divided into groups with no varices, small varices, or large risky varices. In addition, values of Fibrosis-4 score(FIB-4), aminotransferase-to-platelet ratio index(APRI), and platelet count/splenic diameter ratio(PC/SD) were also calculated.RESULTS Detection of large varies is a multi-factorial process, affected by many variables. Choosing binary logistic regression, dependent factors were either large or small varices while independent factors included CT variables such coronary vein diameter, portal vein(PV) diameter, lieno-renal shunt and other laboratory noninvasive variables namely FIB-4, APRI, and platelet count/splenic diameter. Receiver operating characteristic(ROC) curve was plotted to determine the accuracy of non-invasive parameters for predicting the presence of large esophageal varices and the area under the ROC curve for each one of these parameters was obtained. A model was established and the best model for prediction of large risky esophageal varices used both PC/SD and PV diameter(75% accuracy), while the logistic model equation was shown to be(PV diameter ×-0.256) plus(PC/SD ×-0.006) plus(8.155). Values nearing 2 or more denote large varices.CONCLUSION This model equation has 86.9% sensitivity and 57.1% specificity, and would be of clinical applicability with 75% accuracy.

Pathological characterization of occult hepatitis B virus infection in hepatitis C virus-associated or non-alcoholic steatohepatitis-related hepatocellular carcinoma

Occult hepatitis B virus(HBV)infection,by definition,is a state in which infection with this virus does not manifest with the conventional diagnostic laboratory criteria reserved for the obvious form of HBV infection.As a result,occult HBV infection is commonly a surprise finding discovered accidently during the evaluation of other apparent liver diseases,such as hepatitis C virus(HCV)infection or non-alcoholic fatty liver disease and,more importantly,their evolution into life-threatening hepatocellular carcinoma.As infection with HCV and occult HBV is rarely considered when assessing these more obvious conditions,and in an attempt to offer a better understanding of this phenomenon,this study attempted to shed some light onto the uniqueness of occult HBV infection by addressing the natural history of HBV and HCV infections,as well as non-alcoholic fatty liver disease.This was carried out by taking into account the exclusive integration process undertaken by the HBV genome into infected host hepatocytes,with consideration given to conditions which afford reactivation of the occult infection and stress on the molecular mechanisms that underlie occult HBV infection.Finally,the clinical outcome of occult HBV infection and its relation to hepatocellular carcinoma is analyzed.