Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model

Abstract

Liver biopsy is required for staging hepatic fibrosis in patients with chronic hepatitis C, but it is an expensive procedure with occasional complications and poor patient acceptance. This cohort study was designed to assess the accuracy of a noninvasive method aimed to discriminate between patients with and without significant liver fibrosis (stages 2-4 versus 0-1). Clinically relevant variables were analyzed in a cohort of 476 consecutive untreated patients (estimation group, 351 patients; validation group, 125 patients) with chronic hepatitis C who underwent a liver biopsy. Multivariate analysis identified age, gamma glutamyl transpeptidase (GGT), cholesterol, platelet count, and prothrombin time as independent predictors of fibrosis. We constructed a model and a score system combining age, GGT, cholesterol, and platelet count that proved useful to identify patients without significant hepatic fibrosis. The area under the ROC curve was 0.86 for the estimation group and 0.81 for the validation group. Using the best cutoff score (less than 4.2), presence of significant fibrosis (F2 to F4) could be excluded with high accuracy (negative predictive value of 96%) in 125 (36%) of 351 patients. Similarly, it could be excluded with the same certainty in 49 (39%) of the 125 patients of the validation group. Only 2 patients with liver fibrosis stage 2 were incorrectly classified. In conclusion, a combination of easily accessible variables accurately predicts the absence of significant fibrosis and might render liver biopsy unnecessary in more than one third of patients with chronic hepatitis C. (HEPATOLOGY 2002;36:986-992.)

Non-invasive diagnosis of liver fibrosis in chronic hepatitis C

“…In the original study, the AUROC was 0.86 for the estimation group and 0.81 for the validation group in diagnosing significant fibrosis [48] . However, in a recent systematic review, the median AUROC from 22 studies [24] AST and platelet count 0.77 81% 95% 0.84 77% 94% FIB-4 3 [41] Age, AST, ALT and platelet count 0.74 64% 79% 0.87 90% 92% Forns index [48] Age, platelet count, cholesterol levels, and GGT 0.76 88% 94% 0.87 98% 91% Fibro index [50] Platelet count, AST, and gamma globulin 0.76 94% 97% 0.86 70% 91%…”

“…The Forns index is based on age and three additional simple tests: platelet count, cholesterol levels, and GGT [48] . In the original study, the AUROC was 0.86 for the estimation group and 0.81 for the validation group in diagnosing significant fibrosis [48] .…”

Non-Invasive Assessment of Liver Fibrosis in a Rat Model: Comparison of Shear Wave Elastography with Serologic Tests

“…volving the single serum marker such as hyaluronic acid (HA) (6), and combined index models such as aspartate aminotransferase (AST) to platelet (PLT) ratio index (APRI), AST to alanine aminotransferase (ALT) ratio (AAR), fibrosis index based on the 4 factors (FIB-4), and Forns index (7)(8)(9)(10). However, the efficacy of these biomarkers in assessing and monitoring disease progression remains controversial.…”

Combined acoustic radiation force impulse, aminotransferase to platelet ratio index and Forns index assessment for hepatic fibrosis grading in hepatitis B

“…Among these, AST platelet ratio (APRI) is a serum hepatic function test which has been proposed as a non-invasive tool for the assessment of liver fibrosis in CHB [12] or chronic hepatitis C [13] . Another important serum test is Forns index method, which uses simple obtained parameters including age, gamma-glutamyltransferase (GGT), cholesterol, and platelet count (PLT), but it requires a relatively complicated calculation [14] . One of the advantages of APRI and Forns index over the other noninvasive tests is that they are based on readily available blood tests and simple to use.…”