Background/Aim: Many non-invasive alternatives to liver biopsy for assessment of hepatic
fibrosis are proposed, yet their accuracy and applicability remain questionable. This study
assesses the diagnostic and predictive values of 8 simple, inexpensive serum markers of liver
fibrosis in Egyptian patients with chronic hepatitis C virus (HCV) infection. Subjects &
Methods: Complete blood count (CBC), alanine aminotransferase(ALT), aspartate aminotransferase(
AST), serum bilirubin, serum albumin, prothrombin time (PT), international
normalized ratio (INR) and liver biopsy were examined for 142 patients with chronic HCV
infection. Fibrosis (F) was staged using METAVIR scoring system (F0-F4). AST/ALT ratio
(AAR), Age-platelets index (API), AST-platelets ratio index (APRI), cirrhosis discriminate
score (CDS), King, FIB-4, Lok's {Hepatitis C Antiviral Long-term Treatment Against Cirrhosis
(HALT-C)} model, and Pohl scores were calculated using published formulas. Area under
receiver operating characteristic curves (AUROC) was applied to determine the sensitivity,
specificity, positive predictive value (PPV), and negative predictive value (NPV) of each
assessed marker. Results: Among the assessed scores, FIB-4 and King scores were superior
to others for prediction of significant fibrosis (F2-F3) and cirrhosis (F4). The diagnostic
performance of FIB-4 was 59% (AUROC 0.59) with 80% sensitivity, 41% specificity, 94%
PPV, 65.2% NPV, at cutoff 0.98 while that of King score was 57% (AUROC 0.57) with
80% sensitivity, 40% specificity, 86.4% PPV, 60% NPV at cutoff 8.2. When the 2 markers
were combined, the overall accuracy was 80.7% with 87.5% sensitivity, 64.7% specificity,
85.36% PPV, 68.75% NPV in patients with F2 -F3. For predicting cirrhosis (F4), the
diagnostic performance of FIB-4 was 81% (AUROC 0.81) with 90% sensitivity, 65% specificity,
93.75% PPV, 88.2% NPV at cut-off 1.3, and that of King score was 79% (AUROC
0.79) with 90% sensitivity, 53% specificity, 96.7% PPV, 84.8% NPV at cut-off 9.8. When
the 2 markers are combined the overall accuracy was 89.79% with 93.75% sensitivity,
82.35% specificity, 90.9% PPV, 87.5% NPV. Conclusion: FIB-4 and King scores were the
most accurate among different non-invasive fibrosis markers in Egyptian patients with chronic
HCV and their accuracy improves when they are combined. |
