Surgery, Gastroenterology and Oncology

Introduction: Due to the relatively low prevalence of hepatitis delta in Europe, Romania is one of the main countries in the region that can provide data on long-term prognosis of patients with this condition.

Methods: We performed a retrospective study to assess liver disease progression and to compare non-invasive methods for assessing liver fibrosis in patients with chronic hepatitis B and delta under current active surveillance at the National Institute for Infectious Diseases Prof. Dr. Matei Balasa, Bucharest, Romania.

Results: The study group included 64 patients with a median age of 54 (IQR: 38, 59) years, and a male-to-female ratio of 0.7:1, accounting for 183.6 patient-years of follow-up. We identified a biphasic distribution of liver fibrosis in patients with hepatitis D from our cohort, with two peaks, one at mild to moderate fibrosis and the second at moderate to advanced liver fibrosis. We recorded a significant decrease in thrombocyte count from baseline to the third evaluation (mean decrease 17,000 uL, p=0.007, Z=-2.7), a pattern not seen when analyzing coagulation and liver function. We recorded no significant changes over time in terms of cytolysis, renal function, fasting plasma glucose, or lipid profile. We identified a moderate correlation between FibroTest and FIB-4 values (p=0.008, rs=0.40), and a weak correlation between FibroTest and APRI values (p=0.016, rs=0.36). We also identified a moderate correlation between ActiTest and FIB-4 values (p=0.006, rs=0.45), and for FibroTest and APRI (p=0.001, rs=0.56).

Conclusions: We identified an accelerated decrease in thrombocyte counts in patients with hepatitis delta without advanced liver fibrosis, unparalleled by a decrease in liver function. FIB-4 might offer a more suitable estimate of liver fibrosis than APRI, while both FIB-4 and APRI scores appear to give a fair evaluation of the necroinflammatory activity in patients with hepatitis delta.

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