From the Guidelines
The METAVIR score is a critical assessment tool for determining the severity of liver disease, with a fibrosis score ranging from F0 to F4 and an activity score from A0 to A3, guiding treatment decisions and predicting outcomes in patients with chronic liver disease, such as hepatitis C. The METAVIR scoring system evaluates two key components: fibrosis (scarring) and inflammation (activity), with the fibrosis score indicating the extent of liver scarring and the activity score measuring the degree of inflammation and hepatocellular necrosis 1.
Key Components of METAVIR Score
- Fibrosis score:
- F0: no fibrosis
- F1: portal fibrosis without septa
- F2: portal fibrosis with few septa
- F3: numerous septa without cirrhosis
- F4: cirrhosis
- Activity score:
- A0: no activity
- A1: mild activity
- A2: moderate activity
- A3: severe activity According to the EASL recommendations on the treatment of hepatitis C, assessing liver disease severity using the METAVIR score is necessary prior to therapy, as it influences the choice of treatment regimen, post-treatment prognosis, and surveillance for hepatocellular carcinoma (HCC) 1.
Clinical Application of METAVIR Score
- Diagnosing clinically inapparent cirrhosis (METAVIR score F4) or advanced (bridging) fibrosis (METAVIR score F3) is crucial for guiding treatment decisions and predicting outcomes.
- Non-invasive methods, such as liver stiffness measurement and fibrosis biomarkers (e.g., APRI and FIB-4), can be used to assess liver disease severity, especially in patients with chronic hepatitis C, although they may have limitations in certain populations 1.
From the Research
Definition and Purpose of the Metavir Score
- The Metavir score is a system used to evaluate the stage of fibrosis and histological activity in liver diseases, particularly in chronic hepatitis C [(2,3,4,5,6)].
- It grades the stage of fibrosis on a five-point scale, from F0 (no fibrosis) to F4 (cirrhosis), and histological activity on a four-point scale, from A0 (no activity) to A3 (severe activity) 4.
Application and Validation of the Metavir Score
- The Metavir score has been validated for use in patients with chronic hepatitis C 4 and has also been applied to patients with HIV-hepatitis B co-infection 3.
- The score has been shown to have good correlation with non-invasive methods, such as liver stiffness measurement [(2,5)].
- Virtual slide technology has been validated for use in assessing fibrosis and activity using the Metavir score 3.
Factors Associated with Fibrosis Progression
- The Metavir score has been used to assess the natural history of liver fibrosis progression in patients with chronic hepatitis C 4.
- Factors associated with an increased rate of fibrosis progression include age at infection older than 40 years, daily alcohol consumption of 50 g or more, and male sex 4.
Comparison with Other Scoring Systems
- The Metavir score has been compared to other scoring systems, such as the Kleiner score 5.
- The enhanced liver fibrosis (ELF) score has been evaluated as an alternative to the Metavir score for estimating the severity of liver fibrosis 6.
- Transient elastography (TE) has been shown to be more accurate than the ELF score in estimating liver fibrosis severity 6.