How to Assess Liver Cirrhosis

(1) Acti Test Fibro Test

The major hepatological consequence of hepatitis C infection is the progression of fibrosis (scars) to cirrhosis.

Activity and fibrosis are two major histological features of chronic hepatitis C.

One of the few validated scoring systems is called METAVIR scoring system. This system assesses histological lesions in chronic hepatitis C using two separate scores, one for necro-inflammatory grade (A for Activity) and another for the stage of fibrosis (F for Fibrosis).

N.B: Liver Fibrosis Progression occurs in two thirds of patients.

Stages of Fibrosis (F) are:

FO= No fibrosis,

F1= Portal fibrosis without septa,

F2= Portal fibrosis with rare septa,

F3= Numerous septa without cirrhosis,

F4= Cirrhosis.

Liver Activity Grade activity (A) are:

A0= No histological activity,

A1= Minimal activity,

A2= Moderate by integration of the severity of the intensity of both piecemeal (periportal) and lobular necrosis.

(2) Hyaluronic Acid (HA) Test

Serum HA levels can be elevated in various liver diseases characterized by liver fibrosis and cirrhosis, due to decreased hepatic removal and/or increased hepatic production of HA during liver inflammation. Increased HA levels have shown a better correlation with the degree of histopathological damage to the liver than conventional liver function tests including ALT/AST, alkaline phosphatase and bilirubin.

It has also been shown that HA levels reflect the extent of hepatic fibrosis in patients with chronic hepatitis C and may be useful in monitoring the response to interferon alpha treatment. Similar correlation has been found in patients with alcoholic cirrhosis and primary biliary cirrhosis. HA levels have been shown to be an early marker of liver damage from toxic agents such as ethanol, acetaminophen and bacterial lipopolysaccharide, as pathological changes of the sinusoidal endothelial cells in response to these agents precede pathological changes of the hepatocytes.