Details:

Alternative Title:
Clin Infect Dis
Personal Author:
Holmberg, Scott D. ; Lu, Mei ; Rupp, Loralee B. ; Lamerato, Lois E. ; Moorman, Anne C. ; ... More +
Holmberg, Scott D. ; Lu, Mei ; Rupp, Loralee B. ; Lamerato, Lois E. ; Moorman, Anne C. ; Vijayadeva, Vinutha ; Boscarino, Joseph A. ; Henkle, Emily M. ; Gordon, Stuart C. Less -
Description:
Background

Liver biopsy remains critical for staging liver disease in hepatitis C virus (HCV)–infected persons, but is a bottleneck to evaluation, follow-up, and treatment of HCV. Our analysis sought to validate APRI (aspartate aminotransferase [AST]–to-platelet ratio index) and FIB-4, an index from serum fibrosis markers (alanine amino-transferase [ALT], AST, and platelets plus patient age) to stage liver disease.

Methods

Biopsy results from HCV patients in the Chronic Hepatitis Cohort Study were mapped to an F0–F4 equivalent scale; APRI and FIB-4 scores at the time of biopsy were then mapped to the same scale.

Results

We identified 2372 liver biopsies from HCV-infected patients with contemporaneous laboratory values for imputing APRI and FIB-4. Fibrosis stage distributions by the equivalent biopsy scale were 267 (11%) F0; 555 (23%) F1; 648 (27%) F2; 394 (17%) F3; and 508 (21%) F4. Mean APRI and FIB-4 values significantly increased with successive fibrosis levels (P < .05). The areas under the receiver operating characteristic curve (AUROC) analysis distinguishing severe (F3–F4) from mild-to-moderate fibrosis (F0–F2) were 0.80 (95% confidence interval [CI], .78–.82) for APRI and 0.83 (95% CI, .81–.85) for FIB-4. There was a significant difference between the AUROCs of FIB-4 and APRI (P < .001); 88% of persons who had a FIB-4 score ≥2.0 were at stage F2 or higher.

Conclusions

In a large observational cohort, FIB-4 was good at differentiating 5 stages of chronic HCV infection. It can be useful in screening patients who need biopsy and therapy, for monitoring patients with less advanced disease, and for longitudinal studies.


Subject:
[+]
Adolescent
Adult
Aged
Alanine Transaminase
Aspartate Aminotransferases
Biomarkers
Biopsy
Clinical Laboratory Techniques
Female
Hepatitis C, Chronic
Humans
Liver Cirrhosis
Mass Screening
Middle Aged
Platelet Count
Serum
Severity Of Illness Index
Young Adult

Source:
Clin Infect Dis. 57(2):240-246.
Pubmed ID:
23592832
Pubmed Central ID:
PMC5672918
Document Type:
Journal Article
Funding:
CC999999/Intramural CDC HHS/United States
Place as Subject:
United States
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:acccda664ed13fb4fb3c882df46e238ab2bdf4827a5fe207b728f57b03a69953
File Type:

Supporting Files

• 	nihms916714.nxml	xml
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  	nihms916714f1.jpg	jpeg

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