Development and validation of a model to diagnose cirrhosis in patients with hepatitis C.
OBJECTIVE
Although noninvasive markers predictive of cirrhosis in patients with chronic hepatitis C have been examined, none has proved sufficiently accurate for clinical use. The aim of this study was to develop an accurate model that can be easily used by clinicians to predict the probability of cirrhosis in hepatitis C patients from readily available clinical and laboratory information.


METHODS
We identified 264 consecutive patients with established chronic hepatitis C infection and extracted multiple physical examination and biochemical variables (recorded before liver biopsy). Similar data were extracted from charts at another hospital.


RESULTS
Logistic regression identified the following independent predictors of cirrhosis: platelet count < or = 140,000/ mm3, spider nevi, AST > 40 IU/L, and male gender. Male and female patients with normal values for platelet count and AST and no spider nevi had low probabilities of cirrhosis: 1.8% (95% CI = 0.4-7) and 0.03% (95% CI = 0.003-0.04), respectively. Male patients with abnormal values on all three other predictors had a probability of cirrhosis of 99.8% (95% CI = 98.7-100). Over 48% of study patients had a low (< or = 1.8%) or a very high (> or = 99.8%) predicted probability of cirrhosis. The model had area under the receiver operating characteristic curve of 0.938 (95% CI = 0.91-0.97) and 93.4% in an internal validation. The model accurately distinguished patients with and without cirrhosis (area under the receiver operating characteristic curve = 93.3%) in 102 hepatitis C patients from another hospital.


CONCLUSIONS
In patients with hepatitis C, four readily available variables together predict cirrhosis accurately. Successful validation in hepatitis C patients at another hospital with lower prevalence of cirrhosis suggests this model's potential for broad applicability.
Kaul
Vivek
V
Office for Research and Technology Development, Department of Pathology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
Friedenberg
Frank K
FK
Braitman
Leonard E
LE
Anis
Uzma
U
Zaeri
Nayere
N
Fazili
Javid
J
Herrine
Steven K
SK
Rothstein
Kenneth D
KD
D000328:Adult; D000368:Aged; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010976:Platelet Count; D011336:Probability; D012372:ROC Curve; D012307:Risk Factors; D012737:Sex Factors; D013684:Telangiectasis / Q000150:complications