Abstract

Introduction: The non-invasive markers of fibrosis are currently validated in viral hepatopathies but less validated in other dysimmune liver diseases. Very few studies have focused on the place of non-invasive markers of fibrosis in the overlap syndrome. The aim of our study is to determine the correlation between non-invasive markers of fibrosis and histological fibrosis scores in overlap syndrome.

Methods: We conducted a retrospective study that collected all patients with an overlap syndrome: primary biliary cholangitis - autoimmune hepatitis or primary sclerosing cholangitis - autoimmune hepatitis. The APRI and FIB-4 scores were calculated at the time of diagnosis and one year after treatment. A liver biopsy specifying the degree of fibrosis according to Metavir was performed at the time of diagnosis. Liver elastography was done after one year of treatment. Fibrosis was considered significant from F2 for hepatic elastography and Metavir score and a cut-off > 1.5 and > 3.25 for APRI and FIB-4, respectively. The Spearman correlation test and the ROC curve were used to analyze the data.

Results: Our study involved 56 patients divided into 52 women and 4 men of average age 51.1 years (30 - 73 years). Autoimmune hepatitis was associated with primary biliary cholangitis in 89.3% of cases and primary sclerosing cholangitis in 10.7% of cases. Spearman's correlation analysis did not show a correlation between serum markers measured at the time of diagnosis and the degree of histological fibrosis (r = 0.5, p = 0.001). Among the 52 patients who would have significant fibrosis according to the APRI score, 20 patients had no significant histological fibrosis (F0, F1). Among the 48 patients who would have significant fibrosis according to the FIB-4 score, 30 actually had significant fibrosis (> = F2). After one year of treatment, 54 patients underwent hepatic elastography, which showed significant fibrosis in 70.3% of cases (38 patients). Correlation analysis did not show any correlation between serum markers of fibrosis and hepatic elastography. Among the 38 patients with significant fibrosis according to the measurement of hepatic elastography, 16 patients and 12 others were presumed to have no significant fibrosis according to the APRI and FIB-4 scores, respectively.

Conclusion: In our study, we did not find any correlation between the different non-invasive markers of fibrosis and the results of the liver biopsy, which remains to this day the gold standard for assessing liver fibrosis in dysimmunitary disorders like overlap syndrome.

Keywords: Non-Invasive Markers; Fibrosis; Overlap Syndrome

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