Fibroindex, a practical index for predicting significant fibrosis in patients with chronic hepatitis C

Abstract

Diagnosis of the stage of liver fibrosis in chronic hepatitis C is essential for making a prognosis and deciding on antiviral therapy. In the present study a simple model consisting of routine laboratory tests was constructed and then validated in cross-sectional and longitudinal investigations. Consecutive treatment-naive patients with chronic hepatitis C who had undergone liver biopsy were divided into 2 cohorts: an estimation set (n ‫؍‬ 240) and a validation set (n ‫؍‬ 120). A longitudinal set consisted of 30 patients who had undergone a liver biopsy twice, before and after IFN treatment. The FibroIndex was derived from the platelet count, AST, and gamma globulin measurements in the estimation set. The areas under the ROC curves of the FibroIndex for predicting significant fibrosis were 0.83 and 0.82 for the validation set, better than those of the Forns index and the aminotransferaseto-platelet ratio index (APRI). Using the best cutoff values, whether significant fibrosis was present was diagnosed with high positive predictive values, and 35% of patients could avoid liver biopsy. In the longitudinal set, there was a significant decrease in the FibroIndex of 14 patients whose fibrosis stage improved, and a significant increase in that of 5 patients whose fibrosis stage deteriorated. Change in the FibroIndex correlated significantly with variation in fibrosis stage. There was no such correlation with the Forns index or the APRI. Conclusion: The FibroIndex is a simple and reliable index for predicting significant fibrosis in chronic hepatitis C and could also be used as a surrogate marker during antifibrotic treatment for chronic hepatitis C. (HEPATOLOGY 2007;45:297-306.)

Diagnosis and Quantitation of Fibrosis

“…One study in chronic HCV patients included an estimation group of 240 patients and a validation group of 120 patients. 74 Both these groups were treatment naive. The authors also examined a longitudinal group of 30 patients who had undergone a liver biopsy before and after interferon treatment.…”

“…By determining cut-off values, they found a significant decrease in the FibroIndex of 14 patients whose fibrosis stage improved and a significant increase in that of 5 patients whose fibrosis stage increased in the longitudinal group. 74 …”

Valor preditivo de marcadores séricos de fibrose hepática em pacientes portadores de hepatite crônica viral C

“…A infecção pelo vírus da hepatite C (VHC) afeta cerca de 170 milhões de pessoas, aproximadamente 3% da população mundial (9) . Estima-se que 54% a 86% dos pacientes infectados evoluam para a forma crônica, predispondo a complicações, como cirrose, falência hepática e hepatocarcinoma (23) .…”

Utility of Platelet Count for Predicting Cirrhosis in Alcoholic Liver Disease: Model for Identifying Cirrhosis in a US Population

“…The AST platelet count index (APRI index) that was developed was shown to have good sensitivity and specificity for predicting cirrhosis in patients with hepatitis C, but in patients with alcoholic cirrhosis it was found to have low sensitivity and specificity 10 . The PGA index (prothrombin, gamma glutamyl transpeptidase, and apolipoprotein AI [ApoA1] levels) has been shown to have good accuracy for detecting cirrhosis in patients with alcoholic liver disease 11 . The FibroIndex uses the platelet count, AST level, and gamma globulin level to detect significant fibrosis in chronic hepatitis C 12 , but its accuracy has yet to be validated.…”

“…This effect of alcoholinduced thrombocytopenia lasts for 5 to 7 days after alcohol abstinence 7 , and the platelet count should reach its normal level after 7 days of abstinence from alcohol intake. Various prediction models and scoring systems have been proposed for predicting cirrhosis in alcoholics, but these models have either not been validated or were found to be too specialized and not routinely available for clinical use [9][10][11] . Therefore, we aimed to study the role of platelet count for identifying underlying cirrhosis in patients with alcoholic liver disease and with recent alcohol intake.…”