Identifying Possible Hepatic Fibrosis of Hepatitis B Origin Using Non-invasive Markers: A Case-control Study in the South West Region of Cameroon
Kukwah Anthony Tufon *
Department of Microbiology and Parasitology, University of Buea, Buea, South West Region, Cameroon and Buea Regional Hospital, Buea, Southwest Region, Cameroon.
Henry Dilonga Meriki
Department of Microbiology and Parasitology, University of Buea, Buea, South West Region, Cameroon and Buea Regional Hospital, Buea, Southwest Region, Cameroon and Department of Public Health and Hygiene, Faculty of Health Science, University of Buea, Buea, Southwest Region, Cameroon.
Kwenti Emmanuel Tebit
Department of Microbiology and Parasitology, University of Buea, Buea, South West Region, Cameroon and Buea Regional Hospital, Buea, Southwest Region, Cameroon and Department of Public Health and Hygiene, Faculty of Health Science, University of Buea, Buea, Southwest Region, Cameroon and Department of Medical Laboratory Science, Faculty of Health Science, University of Buea, Buea, Southwest Region, Cameroon.
Teuwafeu Denis Georges
Buea Regional Hospital, Buea, Southwest Region, Cameroon and Department of Internal Medicine, Faculty of Health Science, University of Buea, Buea, Southwest Region, Cameroon.
Nyeke James Tony
Department of Microbiology and Parasitology, University of Buea, Buea, South West Region, Cameroon and Buea Regional Hospital, Buea, Southwest Region, Cameroon.
Nicholas Tendongfor
Department of Public Health and Hygiene, Faculty of Health Science, University of Buea, Buea, Southwest Region, Cameroon.
George Enow-Orock
Buea Regional Hospital, Buea, Southwest Region, Cameroon and Department of Biomedical science, Faculty of Health Science, University of Buea, Buea, Southwest Region, Cameroon.
Damian Nota Anong
Department of Biological science, Faculty of Science, University of Bamenda, Bamenda, North West Region, Cameroon.
*Author to whom correspondence should be addressed.
Abstract
Aim: HBV infection is known to cause liver fibrosis as well as some extrahepatic manifestations. We aimed at assessing hematological changes and identifying possible hepatic fibrosis of Hepatitis B origin using non-invasive markers (NIMs).
Study Design: A hospital-based Case-control study
Place and Duration of Study: Conducted at the Buea Regional Hospital, South West Region of Cameroon from February 2016 to December 2017
Methods: We enrolled HBV infected treatment naïve patients and “healthy” controls. All participants were subjected to alanine aminotransferase (ALT) and aspartate aminotransferase (AST) measurement, Full blood count (FBC), HBsAg, anti-HBc, HIV and HCV tests. Aspartate-platelet ratio index (APRI), fibrosis based on 4 factors (FIB-4), age-platelet index (API) and AST/ALT ratio (AAR) were generated from the test results. A questionnaire was administered to collect demographic data, alcohol consumption and history of liver/kidney disease or metabolic syndrome.
Results: A total of 202 cases and 202 controls were enrolled. Hematocrit (HCT) was significantly higher (p<0.001) in cases than controls. The controls had significantly higher mean values for platelet (p=0.005), neutrophil (p=0.032) and number of individuals with AST/ALT ratio (AAR) ≥1. Liver fibrosis was significantly associated with cases than controls based on APRI (OR:6.06, CI:3.59-10.24), FIB-4 (OR:5.35, CI:2.75-10.39) and API (OR:8.02, CI:1.81-35.55). Among the HBV infected cases, 69 (34.2%), 36(17.8%) and 8(4.0%) had results indicative of fibrosis from at least 2, at least 3 and all 4 NIMs respectively. AAR detected possible fibrosis in 136 HBV infected cases of which up to 77 (56.6%) were not detected as fibrosis by the other NIMs.
Conclusion: HBV infection affects neutrophil percentage, HCT, PLT, APRI, FIB-4 and API in our study population. AAR did not prove to be a reliable NIM. Using at least 3 NIMs for HBV infected patients can significantly scale up their reliability for determining liver fibrosis in clinical practice.
Keywords: HBV infection, APRI, API, FIB-4, AST/ALT ratio, non-invasive markers, hematological changes, liver fibrosis