A Simple Noninvasive Score Based on Routine Parameters can Predict Liver Cirrhosis in Patients With Chronic Hepatitis C (original) (raw)
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Health, 2015
The diagnosis of liver cirrhosis in patients with chronic hepatitis C has not always been easy, since the gold standard method is the liver biopsy, which is an invasive procedure with interobserver accuracy problems and there have been reports of complications including records of deaths due to hemoperitoneum. Cirrhosis changes the prognosis of the subject with hepatitis C and requires a different clinical management. This study aimed to identify clinical and laboratory variables associated with the diagnosis of cirrhosis in the ultrasonography of patients infected with hepatitis C. In a case-control study, we evaluated 70 cirrhotic patients with chronic hepatitis C compared to a control group of 70 non-cirrhotic people with positive HCV. The results showed, through logistic regression analysis, that the variables blood donor and professional athlete, adjusted for alcohol consumption, showed OR 0.24 and 0.18, with p values of 0.044 and 0.035, respectively. We conclude that the diagnosis of cirrhosis in patients with chronic hepatitis C remains challenging, but the patients with the condition of blood donor or professional athlete prove to be less likely to cirrhosis in ultrasonography in the initial consultation.
Predicting the liver histology in chronic hepatitis C: how good is the clinician?
The American Journal of Gastroenterology, 2001
OBJECTIVE: Liver biopsy is believed to be necessary before antiviral treatment in hepatitis C. Studies have found symptoms and biochemistry poorly predictive of grade and stage. In practice, a combination of factors is used to anticipate histology. The aim of this study is to evaluate the ability of global clinical assessment to predict histology in hepatitis C.
European Journal of Gastroenterology & Hepatology, 2015
Background and aims The ability of noninvasive methods to predict the development of cirrhosis has not been established. We evaluated the ability of three noninvasive methods [the Forns index, the aspartate aminotransferase-to-platelet ratio index (APRI), and the Non-Invasive Hepatitis-C-related Cirrhosis Early Detection (NIHCED) score] to determine the risk of developing cirrhosis in chronic hepatitis C. Methods Consecutive patients with chronic hepatitis C who had undergone liver biopsy between 1998 and 2004 were eligible. We used the three methods to evaluate patients at baseline and at follow-up (4-10 years later). When these methods yielded discordant or indeterminate results, a second liver biopsy was performed. Logistic regression models were fitted for each method to predict whether cirrhosis would appear and to predict long-term mortality from cirrhosis. Results We included 289 patients in our study. The mean scores at baseline and at follow-up, respectively, were as follows:
Hepatology, 2003
Information on the stage of liver fibrosis is essential in managing chronic hepatitis C (CHC) patients. However, most models for predicting liver fibrosis are complicated and separate formulas are needed to predict significant fibrosis and cirrhosis. The aim of our study was to construct one simple model consisting of routine laboratory data to predict both significant fibrosis and cirrhosis among patients with CHC. Consecutive treatment-naive CHC patients who underwent liver biopsy over a 25-month period were divided into 2 sequential cohorts: training set (n ؍ 192) and validation set (n ؍ 78). The best model for predicting both significant fibrosis (Ishak score > 3) and cirrhosis in the training set included platelets, aspartate aminotransferase (AST), and alkaline phosphatase with an area under ROC curves (AUC) of 0.82 and 0.92, respectively. A novel index, AST to platelet ratio index (APRI), was developed to amplify the opposing effects of liver fibrosis on AST and platelet count. The AUC of APRI for predicting significant fibrosis and cirrhosis were 0.80 and 0.89, respectively, in the training set. Using optimized cut-off values, significant fibrosis could be predicted accurately in 51% and cirrhosis in 81% of patients. The AUC of APRI for predicting significant fibrosis and cirrhosis in the validation set were 0.88 and 0.94, respectively. In conclusion, our study showed that a simple index using readily available laboratory results can identify CHC patients with significant fibrosis and cirrhosis with a high degree of accuracy. Application of this index may decrease the need for staging liver biopsy specimens among CHC patients. (HEPATOLOGY 2003;38:518-526.) Abbreviations: CHC, chronic hepatitis C; AST, aspartate aminotransferase; ALT, alanine aminotransferase; HCV, hepatitis C virus; IDU, injection drug use; ALP, alkaline phosphatase; ULN, upper limit of normal; ROC, receiver operating characteristics; AUC, area under receiver operating curves; CI, confidence interval; APRI, aspartate aminotransferase to platelet count ratio index. From the Platelets, AST, ALP, White blood count, AST/ALT ratio NA 0.93 (0.88-0.97) NA 0.94 (0.89-0.99) Platelets, AST, ALP 0.82 (0.76-0.88) 0.92 (0.87-0.91) 0.87 (0.80-0.95) 0.94 (0.88-1.00) Platelets, AST 0.80 (0.74-0.86) 0.91 (0.86-0.96) 0.87 (0.79-0.95) 0.93 (0.85-1.00) Platelets, AST/ALT ratio 0.73 (0.66-0.81) 0.90 (0.83-0.98) 0.74 (0.63-0.85) 0.90 (0.81-0.99) APRI 0.80 (0.74-0.87) 0.89 (0.84-0.94) 0.88 (0.80-0.96) 0.94 (0.89-1.00) NOTE. NA, not applicable because not all the variables were significant in the regression model.
Development and validation of a model to diagnose cirrhosis in patients with hepatitis C
The American Journal of Gastroenterology, 2002
Although noninvasive markers predictive of cirrhosis in patients with chronic hepatitis C have been examined, none has proved sufficiently accurate for clinical use. The aim of this study was to develop an accurate model that can be easily used by clinicians to predict the probability of cirrhosis in hepatitis C patients from readily available clinical and laboratory information.
The American journal of gastroenterology, 2015
The severity of liver disease in the hepatitis C virus (HCV)-infected population in the United States remains uncertain. We estimated the prevalence of cirrhosis in adults with chronic hepatitis C (CHC) using multiple parameters including liver biopsy, diagnosis/procedure codes, and a biomarker. Patients enrolled in the Chronic Hepatitis Cohort Study (CHeCS) who received health services during 2006-2010 were included. Cirrhosis was identified through liver biopsy reports, diagnosis/procedure codes for cirrhosis or hepatic decompensation, and Fibrosis-4 (FIB-4) scores ≥5.88. Demographic and clinical characteristics associated with cirrhosis were identified through multivariable logistic modeling. Among 9,783 patients, 2,788 (28.5%) were cirrhotic by at least one method. Biopsy identified cirrhosis in only 661 (7%) patients, whereas FIB-4 scores and diagnosis/procedure codes for cirrhosis and hepatic decompensation identified cirrhosis in 2,194 (22%), 557 (6%), and 482 (5%) patients, ...
Revista Española de Enfermedades Digestivas, 2009
Introduction: liver disease resulting from chronic hepatitis C virus (HCV) infection follows an asymptomatic course towards cirrhosis and its complications in 20-40% of cases. Earlier studies demonstrated that advanced fibrosis is a prognostic factor. The "gold standard" for the evaluation of fibrosis grade is liver biopsy. Our group validated a predictive index-NIHCED-based on demographic, laboratory parameters, and echoghraphic data to determine the presence of cirrhosis. Objective: our objective is to evaluate whether the NIHCED score predicts the presence of advanced fibrosis in patients with chronic HCV infection. Material and methods: this prospective study included patients with chronic HCV infection who underwent liver biopsy and were administered the NIHCED score. Fibrosis grade correlated with the NIHCED score using the ROC curve analysis and Spearman's correlation coefficient. Results: in total 321 patients were included (male/female ratio 1.27) with a mean age of 48 ± 14 years. Liver biopsy showed that 131 (30.5%) had no fibrosis or had portal expansion while 190 (69.5%) had advanced fibrosis or cirrhosis. At a cutoff point of 6, sensitivity was 72%, specificity was 76.3%, positive predictive value (PPV) was 81%, negative predictive value (NPV) was 63.7%, and diagnostic accuracy was 72.5%, with an area under the curve (AUC) of 0.787, and a Spearman's correlation coefficient of r = 0.65. Conclusions: the NIHCED score predicts the presence of advanced fibrosis in an elevated percentage of patients with a need of liver biopsy.
Noninvasive Diagnosis of Liver Fibrosis and Cirrhosis in Chronic Hepatitis C Patients
Journal of Clinical Laboratory Analysis, 2013
Background: We aimed to derive a simple noninvasive test for liver-fibrosis staging and then estimate its performance against four simple noninvasive tests in chronic hepatitis C (CHC) patients. Methods: CHC patients were divided into two cohorts: an estimation set (n = 324) and a validation set (n = 524). Liver fibrosis was staged according to the METAVIR scoring system. Statistical analysis was done using stepwise linear discriminant analysis and area under receiver-operating characteristic curves (AUCs). Results: Biotechnology Research Center (BRC) score was constructed combining several blood markers that proved useful to stage liver fibrosis. Aspartate aminotransferase /alanine aminotransferase ratio (AAR), aspartate to platelet ratio index (APRI), Fibro-α, King, and BRC scores correlated with the histological fibrosis stages with correlation coefficient 0.26, 0.36, 0.58, 0.45, and 0.73, respectively. BRC score produced AUCs 0.87, 0.83, and 0.89 for significant (F2-F4), advanced fibrosis (F3-F4), and cirrhosis (F4), respectively. These results were reproduced in the validation study with no significant difference yielding AUCs 0.85 for F2-F4, 0.82 for F3-F4, and 0.88 for F4. Conclusion: BRC score, a novel noninvasive test, is a useful and easy tool to evaluate liver fibrosis in CHC patients and seems more efficient than AAR, APRI, Fibro-α score, and King's score in this group of Egyptian patients.