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Cited by 4,406Liver Disease Diagnosis and TreatmentHepatitis C virus researchLiver Disease and Transplantation

A Simple Noninvasive Index Can Predict Both Significant Fibrosis and Cirrhosis in Patients With Chronic Hepatitis C

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Wai, Chun-Tao, Greenson, Joel K., Fontana, Robert J., Kalbfleisch, John D., Marrero, Jorge A., Conjeevaram, Hari S., Lok, Anna S.-F.·2003·Hepatology
DOI 10.1053/jhep.2003.50346
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Abstract

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 > or = 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.

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Authors
Wai, C.-T., Greenson, J. K., Fontana, R. J., Kalbfleisch, J. D., Marrero, J. A., Conjeevaram, H. S., & Lok, A. S.-F.
Affiliations
University of Michigan (US)
Corresponding author
Lok, Anna S.-F.
ORCID
Venue
Hepatology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2003-08
Volume
38
Issue
2
Pages
518-526
ISSN
0270-9139 (ISSN-L)
DOI
10.1053/jhep.2003.50346
OpenAlex
W1997865776
Cited by
4,406
References
0
Citations by year
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FWCI
44.67
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm, 4414 d)
Locations
  • Hepatology (publishedVersion)
  • PubMed (publishedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
Funders
  • National Institutes of Health (5r43ai051919-02)
  • National Institute of Allergy and Infectious Diseases (R43-AI-51919)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01DK062498, U01 DK57577, U01DK057577, N01 DK 92323, U01 DK62498)
Topics
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Hepatology › Hepatitis C virus research
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Keywords
chronic hepatitis C, liver fibrosis, liver cirrhosis, AST to platelet ratio index, platelet count, aspartate aminotransferase, alkaline phosphatase, fibrosis staging, liver biopsy, Ishak score
MeSH terms
Adult, Biopsy, Female, Humans, Liver Cirrhosis, Male, Middle Aged, Predictive Value of Tests, Sensitivity and Specificity, Severity of Illness Index, Reproducibility of Results, Models, Statistical, Hepatitis C, Chronic

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