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Preventing & screening for hepatitis D

?What are the specific liver tests – information for HCPCs

Chronic viral hepatitis D can have serious and irreversible consequences on your health (1). In order to properly follow the evolution of your disease, your doctor specialized in hepato-gastroenterology will ask for specific liver tests. Hereby some information that will help you better understand these different exams.

To define the stage of hepatic fibrosis

WHAT IS FIBROSIS?

When the liver is suffering, liver’s cells are destroyed and are gradually replaced by fibers (mainly collagen fibers). This phenomenon is called hepatic fibrosis.

Once fibrosis is at an advanced stage, it evolves to cirrhosis.

Cirrhosis of the liver is a chronic (long-term and progressive) disease that can lead to serious complications. It is characterized by a disorganization of the liver’s architecture related to an abnormal and persistent inflammation. This inflammation may be due to viral hepatitis, such as hepatitis D. Thus, contrary to popular belief, cirrhosis is not exclusively related to excess alcoholic beverages (1).

WHAT ARE THE SPECIFIC TESTS TO BE DONE?

Today the majority of medical examinations are non-invasive, thus being safe and not requiring any hospitalization. However, in some specific cases, a biopsy puncture of the liver is necessary (2).

Non-invasive methods

Different tests (Fibrostest® or Fibrometer®) can be carried out from a simple blood sample (3).

Other non-invasive methods, known as physical methods, are used to assess the state of the liver.

  • Abdominal ultrasound is an easily performed X-ray examination that provides morphological information such as the size or general aspect of the liver.
  • FibroScan® measures the liver hardness, also known as liver elasticity (4). Liver’s hardness can also be measured by abdominal ultrasound equipment's. The more severe the liver damage, the harder the liver is.

The liver biopsy puncture

In addition to the non-invasive tests, your doctor may prescribe a biopsy puncture of the liver. This is the most reliable and specific liver test for assessing the severity of the disease. Under local anesthesia, a small fragment of the liver is collected with a needle to be examined under a microscope (5,6).

Laboratory analysis of this small liver sample enables to determine the degree of liver damage. We talk about METAVIR score. This score is composed of the letter A, which indicates hepatitis activity, while the letter F indicates the stage of fibrosis. These two letters are associated with a number that adjusts the severity of the disease (7,8).

Assessing the cirrhosis’ severity

The assessment of the severity of cirrhosis is carried out using the Child-Pugh score. This score allows to determine the severity of the disease and to associate with it a prognosis (9).

Child-Pugh Score (9,10)

The prognosis of cirrhosis is based on the total number of points:

  • Child-Pugh A (5-6 points): 1-year survival rate of 100%
  • Child-Pugh B (7-9 points): 1-year survival rate of 80%
  • Child-Pugh C (10-15 points): 1-year survival rate of 45 %

Finally, the MELD (Model for End-Stage Liver Disease) score is calculated in the advanced stages of chronic liver disease and is used to predict the vital prognosis of patients. The score, calculated from biological blood data, is used among other things, to determine whether the patient is eligible for a liver transplant (11,12).

Sources

  1. German Liver Foundation. Hepatitis D virus (HDV) / hepatitis D, delta.  https://www.deutscheleberstiftung.de/presse/pressemappe/leber Krankungen/virushepatitis/hepatitis-d/ . June 2020
  2. The gastroenterology portal. Hepatitis D, diagnosis. http://dasgastroenterologieportal.de/Hepatitis_D.html . June 2020
  3. MSD MANUAL edition for medical professionals. Hepatic fibrosis. https://www.msdmanuals.com/de-de/profi/ Krankungen-der-leber,-der-gallenblase-und-der-gallenwege/fibrose-und-zirrhose/hepatis-fibrose . June 2020.
  4. https://www.leber-ratgeber.de/die-leber/diagnose-einer-leber Krankung-leber-ratgeber/index.html June 2020
  5. Gastroenterological group practice. Liver puncture / biopsy https://gastropraxis-osnabrueck.de/untersuchungen/leberpunktion-biopsie/ . June 2020.
  6. Practically a doctor. Liver biopsy. https://www.praktischarzt.de/untersuchungen/biopsie/leberbiopsie/ . June 2020.
  7. Bedossa P, Poynard T. METAVIR cooperative study group. An algorithm for the grading of activity in chronic hepatitis C. Hepatology 1996; 24: 289-93.
  8. Hepatitis and more. Invasive fabrosis diagnostics. https://www.hepatitisandmore.de/archiv/2012-1/invasive-fibrosediagnostik.shtml . June 2020
  9. Cirrhosis of the liver. Child-Pugh Score. https://leberzirrhose.de/child-pugh-haben/gclid=Cj0KCQjwoaz3BRDnARIsAF1RfLdW7eI4wkpypSWfTEL7Od1LeEWkwblGa_gd-3ZriGmDaYVUAJZiYXcaAsOTEALw_wcB . June 2020
  10. Child CG, Turcotte JG Surgery and portal hypertension. In: The liver and portal hypertension. Edited by CG Child. Philadelphia: Saunders 1964: 50-64.
  11. MD Calc. MELD Score. https://www.mdcalc.com/meld-score-model-end-stage-liver-disease-12-older . June 2020
  12. LADR. Model of end stage liver disease (MELD) Score. https://ladr.de/service/rechenprogramme/meld-score. June 2020