Predicting the liver histology in chronic hepatitis C: How good is the clinician?

OBJECTIVE: Liver biopsy is believed to be necessary before antiviral treatm ent in hepatitis C. Studies have found symptoms and biochemistry poorly pre dictive of grade and stage. In practice, a combination of factors is used t o anticipate histology. The aim of this study is to evaluate the ability of global clinical assessment to predict histology in hepatitis C. METHODS: Fifty-four consecutive patients referred to a university center fo r consideration of antiviral therapy were enrolled. Clinical and laboratory data were recorded as was a prediction of the inflammatory grade (0-3) and fibrotic stage (0-3), with fibrotic stage 3 referring to cirrhosis. Liver biopsies were read by a blinded pathologist. The predictive value of the cl inical assessment and individual parameters was assessed. RESULTS: All predictions were less than or equal to1 point off the actual g rade and stage. Thirty-six (66.7%) patients' grades and 41 (75.9%) patients ' stages were exactly predicted. All four cirrhotic patients (sensitivity 1 00%, specificity 94%) and one case of hemochromatosis were correctly predic ted. Spider nevi, organomegaly, white blood cell count less than or equal t o 4 X 10(9)/L, ALT > 120 U/L, bilirubin > 20 mu mol/L, albumin less than or equal to 35 g/L, and ferritin > 200 mug/L predicted grade greater than or equal to2. Stage greater than or equal to2 was associated with age > 40 yr, previous decompensation, spider nevi, organomegaly, white blood cell count : 4 X 10(9)/L, albumin less than or equal to 35 g/L, platelets less than o r equal to 150 X 10(9)/L, and international normalized ratio > 1.2. Grade c orrelated with stage (Spearman coefficient = 0.54, p < 0.001). By multivari ate analysis, ferritin plus spider nevi or hypoalbuminemia was independentl y predictive of inflammation. Spider nevi and thrombocytopenia, with either splenomegaly or hypoalbuminemia, were useful three-variable models for pre dicting fibrosis. The corresponding scoring systems produced useful likelih ood ratios. CONCLUSIONS: Global clinical assessment mirroring clinical practice in a te rtiary liver transplant center is moderately accurate in predicting grade a nd stage in hepatitis C. Liver biopsy is the current gold standard; however , the amount of new information gleaned is less than was perceived. The nee d for routine biopsy before antiviral treatment in hepatitis C should be re evaluated in a multicenter study. (C) 2001 by Am. Coll. of Gastroenterology .