CLINICAL AND GENETIC PREDICTORS AND PROGNOSTIC MODEL OF RAPIDLY PROGRESSIVE HEPATIC FIBROSIS IN CHRONIC HEPATITIS C.

Georgian Med News

Higher State Educational Establishment of Ukraine "Ukrainian Medical Stomatological Academy", Poltava, Ukraine.

Published: July 2016

The search for risk factors for rapid progression of hepatic fibrosis (HF) in chronic hepatitis C (CHC) is a topical scientific and practical task. The purpose of the study is to identify clinical and genetic predictors and create the prognostic model of rapidly progressive HF in CHC. A retrospective cohort study of 125 patients with CHC has been carried out. The logistic regression and ROC-analysis have been applied for statistical data processing. The resulting analysis of 46 potential predictors of rapidly progressive HF in CHC identified the following significant ctiteria: male gender - ОR=3.44 [95% СΙ 1.60-7.39], р=0.001; increased levels of alanine aminotransferase (ALT) - ОR=4.93 [95% СΙ 1.54-15.76], р=0.007, particularly, moderate cytolytic activity - ОR=2.36 [95% СΙ 1.08-5.16], р=0.031; aspartate aminotransferase (АSТ) - ОR=3.65 [95% СΙ 1.41-9.43] р=0.007; γ-glutamiltranspeptidase (GGTP) - ОR=3.63 [95% СΙ 1.73-7.61], р=0.001; total bilirubin - ОR=3.53 [95% СΙ 1.47-8.47], р=0.005; alkaline phosphatase - ОR=9.18 [95% 1.11-75.80], р=0.039; alcohol intake>40 g/day (ОR=3.53 [95% СΙ 1.36-9.17], р=0.009), Gln11Gln genotype of the TLR7 gene (ОR=4.56 [95% СΙ 1.57-13.22], р=0.005), presence of chronic cholecystitis and/or pancreatitis (ОR=5.30 [95% СΙ 1.84-15.25], р=0.002). The prognostic model, comprising 6 predictors (level of GGTP>upper limit of normal (ULN), male gender, Gln11Gln genotype of the TLR7 gene chronic cholecystitis and/or pancreatitis, levels of total bilirubin and АSТ>ULN) have been created, demonstrating the statistical significance (p=0.000) and high operational characteristics (sensitivity - 85.5%, specificity - 68.3%, total number of the appropriate assignments - 76.8%, positive and negative predictive value - 72,6% and 82.7%,, respectively, the AUC ROC-curve - 0.840). Use of the created model will help to predict the rapid progression of HF in CHC and form the risk-group, requiring individual approaches to prescribing antiviral therapy for CHC.

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