C-13-Aminopyrine breath test accurately predicts long-term outcome of chronic hepatitis C

Background & Aims: Although numerous non-invasive tests are currently available to explore liver function and disease activity in patients with HCV-related chronic diseases, none of these indicate the likelihood of disease progression in the individual patient. We aimed at assessing the prognostic ability of C-13(2)-aminopyrine breath test (C-13-ABT) in the prediction of liver fibrosis progression in patients with HCV chronic hepatitis who prospectively entered a long-term follow-up. Methods: Fifty patients with HCV-related chronic disease who underwent paired liver biopsy (at baseline and after a mean period of 86 months) were included in the study. C-13-ABT was carried out at baseline and every 3 years. Histological progression was defined as increase of at least 2 fibrosis units according to Ishak score. Results: Fourteen patients progressed of at least 2 fibrosis units during the follow-up. These patients were more frequently infected with a HCV-1b genotype and had, at baseline, a significantly older age, higher BMI, AST levels, and AST to platelet ratio index (APRI). C-13-ABT was altered in 57% of cases at baseline and in 100% of the cases at 3-year follow-up. In the univariate analysis, age (p = 0.005), BMI (p = 0.006), platelet count (p = 0.03), AST (p = 0.012) and ALT (p = 0.04) levels, APRI (p = 0.03), and baseline C-13-ABT results (p <0.0001) were all independently associated with progression of liver fibrosis. By Cox's multiple regression analysis, the C-13-ABT was the only covariate that significantly predicted liver fibrosis progression (HR 6.7; 95% CI 2.3-20.1; p <0.001). Conclusions: C-13-ABT accurately predicts the risk of disease progression in patients with HCV-related chronic hepatitis.