Background/Aims:We evaluated whether surrogate serum biomarkers for liver injury are comparable to liver biopsy in
Egyptian patients with hepatitis C virus (HCV) infection.
Subjects:Two hundred and twenty Egyptian patients, 91% infected with genotype-4 HCV, undergoing liver biopsy during
evaluation for interferon/ribavirin therapy.
Methods: Liver biopsy scored by the Ishak method was compared to biochemical tests, platelet count and two fibrosis
biomarkers: hyaluronic acid (HA) and YKL-40. Univariate and logistic regression analyses determined independent predictors
of fibrotic, inflammatory, and fatty changes. Biomarkers were evaluated for ability to differentiate between severe
fibrosis/cirrhosis and no/mild fibrosis.
Results:Although increasing age, HA, YKL-40, AST, reduced platelet count, and AST and HA/ platelet count ratios
were associated with fibrosis by univariate analysis, the other variables were not significant after controlling for HA
(p = 0.0001) and age (p = 0.004). Although age and some biomarkers were associated with inflammation, none remained
significant after controlling for fibrosis. YKL-40 (p = 0.04) and aspartate aminotransferase (p = 0.05) remained associated
with steatosis after controlling for fibrosis.
Conclusions: In Egyptians with chronic HCV, young patients with low levels of HA are at very low risk of fibrosis. This
can limit the number of liver biopsies to those whose clinical findings conflict with the biomarker results.