Published online Jul 8, 2017. doi: 10.4254/wjh.v9.i19.850
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
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.
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.
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).
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.