[Viralhepatitis. Croatian Consensus Statement 2013]. / Virusni hepatitis. Hrvatska konsenzus konferencija 2013.

Croatian Consensus Conferences on Viral Hepatitis took place in 2005 and 2009. Considering the numerous novel concepts on the epidemiology, diagnosis and management of viral hepatitis (chronic hepatitis C genotype 1 in particular) that have emerged in the past four years, a new Croatian Consensus Conference on Viral Hepatitis was held in Zagreb on February 28, 2013. The abridged text of the Croatian Consensus Conference on Viral Hepatitis 2013 presents the new concepts on the epidemiology of viral hepatitis, serologic and molecular diagnosis of viral hepatitis, determination of the IL-28 gene promoter polymorphism, fibrosis grading, algorithm for patient diagnostic follow up, treatment of chronic hepatitis C (genotypes 1-6) and hepatitis B, treatment of special populations (children, dialysis patients, transplanted patients, individuals with HIV/HCV co-infection), and therapy side effects.

[Assessment of liver disease severity in patients with chronic viral hepatitis]. / Procjena tezine ostecenja jetre u bolesnika s kronicnim virusnim hepatitisom.

The best indicator of the severity of liver damage and prognosis in chronic viral hepatitis is extension of liver fibrosis. Extension of liver fibrosis can be assessed by liver biopsy and non-invasive physical or biological methods. Biopsy is used to define ethiology, severity (stage of fibrosis) and prognosis of liver disease. These informations are also usefull when estimating the risk-benefit and deciding on the modalities of antiviral therapy. Serological tests and elastography may distinguish significant fibrosis (F > or = 2) from baseline fibrosis (AUROC 0.77-0.83 for serology and 0.84 for elastography) and cirrhosis from noncirrhotic stages (AUROC 0.77-0.86 for serology and 0.9-0.94 for elastography). Individual method of choice with best performance to distinguish cirrhosis from noncirrhotic stages of liver is elastography. Combination of serological tests and transient elastography has 93-95% accuracy to predict liver cirrhosis, and in case of concordant values of both tests biopsy could be avoided in 77-80% of patients. In case of discordant values or those in favour of intermediate stages of fibrosis liver biopsy should be performed because in these situations non-invasive tests are less reliable. According to several studies liver stiffness as assessed by transient elastography has high predictive value for the development of decompensated cirrhosis and portal hypertensive complications and may also discriminate the patients with respect to the predicted 5-year survival.

[Assessment of hepatic injury in patients with chronic viral hepatitis]. / Procjena ostecenja jetrenog parenhima u bolesnika s kronicnim virusnim hepatitisom.

The management and prognosis of chronic viral hepatitis greatly depend on the extent and progression of liver fibrosis. Although liver biopsy is still considered as the gold standard to evaluate hepatic fibrosis, it is an invasive procedure with rare but potentially severe complications. It is also prone to sampling errors. These limitations have stimulated the search for new noninvasive approaches. A number of noninvasive techniques such as indirect or direct markers and measurement of liver stiffness using transient elastography have been proposed for the assessment of hepatic fibrosis. The performance of simple tests derived from routine laboratory parameters appears to be similar to that of more complex and expensive fibrosis panels. Transient elastography seems to be more accurate than blood tests for diagnosing cirrhosis. The goal of disease specific, accurate and sensitive markers of fibrosis is worth the effort. The true success in such an attempt can be characterized as hopeful; however, these noninvasive methods can be anticipated to become an important tool in clinical practice.

[Viral hepatitis: clinical and histological assessment]. / Virusni hepatitis: klinicka i histoloska ocjena.

Viral factors are important in the pathogenesis of liver disease either directly, through cell injury associated with the accumulation of intact virus or viral proteins, or indirectly, through the host immune response. The immune response of the host is more important than viral factors in the pathogenesis of liver injury caused by HBV. There is little genomic variability in HBV, but mutant forms of HBV with mutations in the precore, surface and X genes, as well as the core promoter region have been implicated in a number of clinical syndromes. The mechanisms of viral persistence and hepatocellular injury in patients with hepatitis C infection are poorly understood. Viral infection can produce cellular injury by direct cytotoxicity and by indirect immune-mediated injury. The range of histologic findings in patients with hepatitis B and C is broad, from minimal inflammatory changes to fulminant hepatitis, liver cirrhosis and hepatocellular carcinoma. The goal of histologic analysis is quantitative and qualitative assessment of necroinflammatory lesions and fibrosis, changes of liver structure and follow-up of histologic changes due to the natural course of the disease or antiviral therapy. Subjective impression in the assessment of histologic changes is not satisfactory and numerical indices should be used. Presently, Knodell's index is being replaced by METAVIR system and Ishak system. Clinical assessment of patients with viral hepatitis must include detailed physical examination, description of the clinical course and extrahepatic manifestations, definition of viral factors, histologic assessment of inflammatory activity and degree of fibrosis, and a number of relevant laboratory parameters.