[Comparative study of two models that use biochemical parameters for the non-invasive diagnosis of fibrosis in patients with hepatitis C].
OBJECTIVE
Several models for the prediction of liver fibrosis have been developed which consist of the measurement of routine laboratory data: a) a model combining platelets, gamma-glutamil-transpeptidase, cholesterol and age (Forns model), and b) a model using an aspartate-aminotransferase to platelet ratio index (APRI). Our study was aimed to compare both non-invasive methods to predict mild fibrosis (F0-F1) or to confirm advanced fibrosis (F3, F4) in patients with chronic hepatitis C.


METHODS
We included 199 patients with chronic hepatitis. The average age (standard deviation) was 41 (11) years (16-66), and there were 117 men and 82 women. We found a genotype 1 in 108 patients (54.2%), 45 had a non-1 genotype (22.6%), and 46 (23.1%) had an unknown genotype. Mild fibrosis stage (F0-F1) was found in 96 patients, F2 in 52 and advanced fibrosis (F3-F4) in 51 patients. We calculated the APRI and the Forns's index.


RESULTS
Patients infected with genotype 1 were older (44 [11] vs 36 [4.3] years; p = 0.001), presented higher levels of cholesterol (179 [40] vs 160 [42] mg/dl; p = 0.05) and lower levels of alanine-aminotransferase (112 [86] vs 169 [87] IU/l; p = 0.03). The Forns's model predicted mild fibrosis (F0-F1) in 71.4% while the APRI model did it in 72.7%. The Forns's model confirmed advanced fibrosis in 78.6% against 54.2% from the APRI one. The predictive capacity in both models increased when analyzing patients with the genotype 1. Moreover, the predictive capacity of advanced fibrosis or exclusion of significant fibrosis reached more than 90% when both models were used together in patients with a genotype 1.


CONCLUSIONS
Non-invasive methods for the prediction of liver fibrosis can be very useful in clinical practice, mainly in patients with genotype 1 when the two methods are used together.
Romero Gómez
Manuel
M
Unidad de Hepatología, Hospital Universitario de Valme, Sevilla, España. mromerog@supercable.es
Ramírez Martín del Campo
Marta
M
Otero
M Angeles
MA
Vallejo
Mercedes
M
Corpas
Raquel
R
Castellano-Megías
Víctor M
VM
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers; D001707:Biopsy, Needle; D001774:Blood Chemical Analysis; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008099:Liver / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D015415:Biomarkers