Comparative analysis of non-invasive fibrosis markers: Insights from chronic HBV, HBV+HDV, and HCV infections

Background: Chronic viral hepatitis remains a significant global health burden, with accurate assessment of liver fibrosis being crucial for patient management. This study aimed to evaluate the diagnostic accuracy of non-invasive tests (NITs) for liver fibrosis assessment in patients with chronic hepatitis B (HBV), hepatitis B and D co-infection (HBV + HDV), and hepatitis C (HCV) infections. Methods: A prospective study was conducted on 78 patients with chronic viral hepatitis (22 HBV, 34 HBV + HDV, 22 HCV). Participants underwent magnetic resonance elastography (MRE), transient elastography (TE), and serum biomarker testing (APRI, FIB-4, PIIINP, COL4). MRE was used as the reference standard for liver fibrosis staging. Results: Transient elastography demonstrated the highest diagnostic accuracy for detecting advanced liver fibrosis across all etiologies (AUC 0.95, cutoff 10.2 kPa). The performance of serum biomarkers varied among different viral hepatitis etiologies. In chronic hepatitis B, APRI and FIB-4 showed moderate performance (AUC 0.64), while PIIINP and COL4 demonstrated poor diagnostic accuracy. In HBV + HDV co-infection, all markers showed moderate performance. In chronic hepatitis C, COL4 demonstrated excellent diagnostic accuracy (AUC 0.93), while FIB-4 and APRI showed moderate performance. Conclusions: This study highlights the complex relationship between viral hepatitis etiologies and the performance of non-invasive fibrosis tests. While TE demonstrates high accuracy across all groups, the utility of serum biomarkers varies significantly. These findings underscore the importance of considering the specific viral etiology when selecting and interpreting NITs for liver fibrosis assessment in chronic viral hepatitis patients.

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