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PHYSIOLOGIC STAGING OF LIVER DISEASE
HEPATIQ REPORT
The HEPATIQ report provides six indices of liver disease that may be used for diagnosis, staging, interventions, and monitoring disease progression. It includes color-coded serial and differential graphs with green regions indicating normal. An interpretation of the quantitative indices including a physiologic stage of liver disease is provided based on publications. A sample report is shown below for illustration.
- HEPATIQ Indices
- The HEPATIQ report provides six indices of liver disease that may be used for diagnosis, staging, interventions, and monitoring disease progression.
- (1) PHM - Quantitative Liver Function (normal ≥100). PHM indicates likelihood of liver decompensation. Patients with PHM < 95 have cirrhosis and a 15-fold increase in the risk of outcomes such as ascites, variceal bleeding, hepatic encephalopathy, and death.[5,6,10,15,16,18,19,20,24]
- (2) fLV - Liver Volume (7 ≤ normal < 12). fLV indicates steatotic liver disease when high and shrinking functional volume when low.[8,11,14,21,22,23]
- (3) fSV - Spleen Volume (normal < 2.5). fSV provides a non-invasive measure of portal hypertension.[5,6,10,12,13,15,19,20] May be used for assessing a transjugular intrahepatic portosystemic shunt (TIPS).
- (4) HAI - Alcoholic Hepatitis (normal > -0.1). HAI indicates alcoholic hepatitis when low.[10,15,18,19,20,23,24]
- (5) eFS - Fibrosis Stage (normal = 0, range 0 to 6). eFS estimates fibrosis stage and correlates with Ishak fibrosis.[5,6]
- (6) eEV - Esophageal Varices (normal =0, range 0 to 3). eEV estimates presence and size of esophageal varices and the risk of bleeding.[5,6]
Differential Diagnostics(1) PHM and fLV can be used to differentiate steatohepatitis and non-steatotic cirrhosis.[8,10,11,14,21,22] (2) PHM and fLV reflect intrahepatic hemodynamics allowing differentiation of acute and chronic liver disease.[6,8,10,11,25] (3) PHM and fSV can be used to differentiate infiltrative spleen disease and cirrhotic portal hypertension.[6,12,15,19] (4) HAI and fLV allow differentiation of alcoholic steatohepatitis (ASH) and metabolic dysfunction-associated steatohepatitis (MASH).[8,10,14,18,21,22,23]
- Physiologic Stage HEPATIQ also provides a physiologic stage (different from fibrosis stage) of liver disease [27,28]:
- H0 Normal liver function.
- HA Acute liver disease.
- HS Steatotic liver disease.
- H1 Borderline liver function.
- H2 Steatotic cirrhosis.
- H3 Non-steatotic cirrhosis.
- H4 Decompensation risk.
- H5 Transplant candidate.
Managing Disease Progression(1) Interventions: For HCC patients being considered for radioembolization or chemotherapy, PHM indicates risk of post-intervention liver failure.[6,10,13,15] (2) Transplantation: For patients with severe liver disease but MELD score not high enough for transplant priority, low PHM may be used for transplant priority.[6,10,15,18] (3) Therapy: PHM provides objective monitoring of the efficacy of pharmacological, radiological or surgical therapies for the underlying causes of liver disease.[6,10,15,18,24,28]
(4) Vigilance: HEPATIQ can provide early detection of progressive liver disease prompting a vigilant evaluation for complications.[24,25,28]