This was a cross-sectional study included fifty (50) HCV patients with liver cirrhosis selected from a major university hospital. Approval of the study was obtained by the institutional ethical committee. They were divided into two groups as the following: group I: included 25 HCV cirrhotic patients with HCC and group II: included 25 HCV cirrhotic patients without HCC.
Inclusion criteria: adult HCV cirrhotic patients above 18 years, with or without hepatocellular carcinoma (HCC)
Exclusion criteria: hepatic encephalopathy, ascites or pregnancy, hepatorenal syndrome or hepato-pulmonary syndrome, right side heart failure (liver congestion), extra hepatic tumors, history of liver transplantation, cholestasis, and hepatitis B patients
An informed written consent was obtained for each involved patients for approval to participate in this study. All patients were subjected to the following: full history taking and clinical examination including information on age, sex, gastrointestinal symptoms, comorbidities (diabetes mellitus (DM), hypertension (HTN), and congestive heart failure (CHF)), hepatic encephalopathy, renal impairment, liver transplantation, tumors, and medications.
Blood samples were collected from the patients by vacuum venipuncture, using a dry sterile 5-ml tube. The serum was separated, centrifuged, and aliquoted. Laboratory investigations were done for all the patients including the following: liver function tests as liver enzymes (ALT-AST), serum albumin, bilirubin, prothrombin time and INR, viral hepatitis markers (HBs Ag, anti-HBc, and anti-HCV), complete blood picture and erythrocyte sedimentation rate (ESR), kidney function tests (blood urea and serum creatinine), and serum α-fetoprotein (AFP).
Imaging was performed for all the patients including the following: (a) abdominal ultrasonography, reporting data for liver echogencity, vascularity (portal and hepatic veins), intrahepatic biliary dilation, and focal lesion criteria (site, number, size, and echogencity); also report about the spleen, kidneys, lymph nodes, ascites, and any other abnormality if present. (b) Contrast-enhanced triphasic computerized tomography (CT) confirming HCC diagnosis. (c) Fibroscan on the liver: liver stiffness measurement (LSM) using Fibroscan 402 (Echosens, Paris, France) was done.
Principle of technique: it measures liver stiffness as it is a rapid technique taking less than 5 min that can be easily performed at bedside or in outpatient clinic. It is a noninvasive and painless technique, with results immediately available and it can be safely repeated for follow-up. The results are expressed in kilopascals (kPa), corresponding to the median value of 10 validated measurements according to the manufacturer’s recommendations and the machine scale result ranges from 2.5 to 75 kPa with normal value around 5.5 kPa. The validity results also depend on two important parameters: the interquartile range, which reflects the variability of the validated measures and should not exceed 30% of the median value; the success rate (the ratio of the number of successful measurements to the total number of acquisitions) should be at least 60%.
Technique: the patient was instructed to lie supine. An ultrasound-like probe was placed on the skin over the liver area, typical in the right mid axillary line. The patient felt a gentle flick each time a vibration wave is generated by the probe. Then the patients were evaluated practically according to the following scores:
Modified Child score: evaluation of the severity of liver cirrhosis was obtained in each cirrhotic patient with modified Child-Pugh score. This system relies on clinical and laboratory evaluation including ascites, grade of encephalopathy, serum albumin, bilirubin, and prothrombin time.
Model of End-stage Liver Disease (MELD) score: this is a model for end-stage liver disease for evaluation of the severity of liver cirrhosis in each cirrhotic patient, and this system relies on laboratory evaluation including serum bilirubin, serum creatinine, and INR (international normalized ratio). MELD score = 9.6 × log (creatinine mg/dl) + 3.8 × log (bilirubin mg/dl) + 11.2 × log (INR) + 6.4.
Statistical analysis: statistical presentation and analysis of the present study was conducted, using the mean, standard deviation, and chi-square test by SPSS V.16. Chi-square test was used for comparison between two groups as regards qualitative data. Significance level (P) value was expressed as follows: P value ≥ 0.05 was considered statistically non-significant; P value < 0.05 was considered statistically significant; P value < 0.001 was considered statistically highly significant.