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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Improved Hepascore in hepatitis C predicts reversal in risk of adverse outcome
Angus W Jeffrey, Yi Huang, W Bastiaan de Boer, Leon A Adams, Gerry MacQuillan, David Speers, John Joseph, Gary P Jeffrey
Angus W Jeffrey, School of Medicine, University of Notre Dame, Fremantle, WA 6160, Australia
Yi Huang, Leon A Adams, Gerry MacQuillan, Gary P Jeffrey, School of Medicine and Pharmacology, University of Western Australia, Perth, WA 6009, Australia
Yi Huang, Leon A Adams, Gerry MacQuillan, Gary P Jeffrey, Department of Hepatology, Sir Charles Gairdner Hospital, Perth, WA 6009, Australia
W Bastiaan de Boer, Department of Anatomical Pathology, PathWest, QEII Medical Centre, Perth, WA 6009, Australia
David Speers, Department of Microbiology, PathWest, QEII Medical Centre, Perth, WA 6009, Australia
John Joseph, Department of Biochemistry, PathWest, QEII Medical Centre, Perth, WA 6009, Australia
Author contributions: Jeffrey AW, Huang Y and Jeffrey GP were responsible for study design, data collection and analysis and manuscript preparation; de Boer WB, Adams LA, MacQuillan G, Speers D and Joseph J were involved in data interpretation and manuscript preparation.
Institutional review board statement: The study was reviewed and approved by the Sir Charles Gairdner Hospital Human Ethics Research Committee.
Informed consent statement: This manuscript did not require informed consent as the presented data is anonymized and risk of identification is low. This retrospective study complies with the NHMRC National Statement on Ethical Conduct in Human Research.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data is available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Angus W Jeffrey, School of Medicine, University of Notre Dame, 32 Mouat St, Fremantle, WA 6160, Australia.
angus.jeffrey1@my.nd.edu.au
Telephone: +61-8-94330555 Fax: +61-8-94330544
Received: March 14, 2017
Peer-review started: March 15, 2017
First decision: April 14, 2017
Revised: May 8, 2017
Accepted: May 18, 2017
Article in press: May 19, 2017
Published online: July 8, 2017
Processing time: 112 Days and 9.2 Hours
AIM
To establish if serial Hepascore tests (referred to as delta Hepascore) in those with chronic hepatitis C (CHC) correlate with the increase and/or decrease in risk of liver related complications.
METHODS
Three hundred and forty-six CHC patients who had two Hepascore tests performed were studied. During 1944 patient years follow-up 28 (8.1%) reached an endpoint. The Hepascore is a serum test that provides clinically useful data regarding the stage of liver fibrosis and subsequent clinical outcomes in chronic liver disease.
RESULTS
Patients with a baseline Hepascore > 0.75 had a significantly increased rate of reaching a composite endpoint consisting of hepatocellular carcinoma, liver death, and/or decompensation (P < 0.001). In those with an initial Hepascore > 0.75, a subsequent improved Hepascore showed a significantly decreased risk for the composite endpoint (P = 0.004). There were no negative outcomes in those with a stable or improved delta Hepascore. The minimum time between tests that was found to give a statically significant result was in those greater than one year (P = 0.03).
CONCLUSION
In conclusion, Hepascore is an accurate predictor of liver related mortality and liver related morbidity in CHC patients. Of note, we have found that there is a decreased risk of mortality and morbidity in CHC patients when the patient has an improving delta Hepascore. Repeat Hepascore tests, when performed at a minimum one-year interval, may be of value in routine clinical practice to predict liver related clinical outcomes and to guide patient management.
Core tip: The growing burden of hepatitis C is well recognized. The use of serum fibrosis markers such as Hepascore to monitor change in clinical risk in hepatitis C has a significant potential benefit to optimise the management in these patients. However, there is no information on the value of serial serum fibrosis tests and their improvement over time in determining changes in liver related clinical outcomes. We have found that there is a decreased risk of mortality and morbidity in chronic hepatitis C patients when the patient has an improving delta Hepascore, and serial tests may be of use in clinical practice.
