Do serum markers of liver fibrosis vary by HCV infection in patients with alcohol use disorder?

Introduction: HCV infection is frequent in patients with alcohol use disorder (AUD). Ethanol and hepatitis C have a synergistic effect that increases the risk of end-stage liver disease. We aimed to assess fibrosis of the liver in patients admitted to treatment of AUD.

Methods: Data were collected in two hospital units between 2000 and 2014. Liver fibrosis was assessed by serum biomarkers APRI, FIB-4 and Forns, and Advanced Liver Fibrosis (ALF) was defined if APRI > 1.5, FIB-4 > 3.25 or Forns > 6.9. Correlations were analyzed by Pearson's coefficients and logistic regression models were used.

Results: 1313 patients (80% M) had complete data; age at admission was 45 years (IQR: 39-52 yrs), age of initial regular alcohol consumption was 20 years (IQR: 17-26 yrs) and the amount of alcohol consumed preceding admission was 200 g/day (IQR: 120-270 g/day). Prevalence of HCV infection was 18%. Prevalence of ALF in HCV positive patients was 40.6% by APRI, 30.6% by FIB-4, and 43.3% by Forns. Correlations were high for APRI vs. FIB-4 r = 0.906, APRI vs. Forns r = 0.710, and, FIB-4 vs. Forns r = 0.825. There was no significant difference in the APRI/FIB-4 correlation by HCV status (z = 1.35, p = 0.177). However, the APRI/Forns correlation was significantly higher in HCV positive patients (p < 0.001). Patients with HCV infection were two times more likely to present with ALF at admission (OR = 2.1, 95%CI:1.5-3.1).

Conclusions: HCV infection is associated with severity of fibrosis in patients with excessive alcohol consumption. In this context, APRI and FIB-4 are highly correlated which facilitates the assessment of liver damage.