title: Cirrhosis in hepatitis C virus-infected patients can be excluded using an index of standard biochemical serum markers.
abstract: OBJECTIVE
  Assessment of liver histology is pivotal in prognostication and decision-making regarding therapeutic intervention in patients with chronic hepatitis C virus (HCV). Being an invasive procedure, the liver biopsy is associated with complications, and a non-invasive alternative would be preferable.
  
  
  METHODS
  Sera samples from 179 patients with chronic HCV infection collected at the time of liver biopsy were analyzed using routinely available biochemical markers of liver disease, and liver histology was evaluated using the Ishak protocol. The relationship between the serum biochemical markers and cirrhosis (Ishak stage > or = 5) as well as bridging fibrosis (Ishak stage > or = 3) was examined.
  
  
  RESULTS
  A strong association was found in the multivariate logistic regression analysis between fibrosis stage and aspartate aminotransferase (AST), platelet count and prothrombin-INR (international normalized ratio). An index (the Göteborg University Cirrhosis Index (GUCI)) was calculated using these variables: normalized ASTxprothrombin-INRx100/platelet count (x 10(9)/l). Using a cut-off value of 1.0, the sensitivity was 80% and the specificity 78% for diagnosis of cirrhosis, and the negative predictive values (NPV) and positive predictive values (PPV) were 97% and 31%, respectively. The GUCI score proved slightly superior for sensitivity, specificity, NPV, PPV, and the area under the receiver operating characteristic (ROC) curve for prediction of cirrhosis and bridging fibrosis compared with the AST to platelet ratio index (APRI), which has been reported as a predictor of significant fibrosis and cirrhosis.
  
  
  CONCLUSIONS
  An index using routinely available biochemical markers can with a high degree of accuracy discriminate patients with from those without hepatitis C-related cirrhosis.
authors.affiliation: Department of Infectious Diseases, Göteborg University, Sweden.
authors.forename: Sara
authors.initials: S
authors.lastname: Islam
authors.forename: Linda
authors.initials: L
authors.lastname: Antonsson
authors.forename: Johan
authors.initials: J
authors.lastname: Westin
authors.forename: Martin
authors.initials: M
authors.lastname: Lagging
mesh_terms: D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D007150:Immunohistochemistry; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000401:mortality / Q000821:virology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010976:Platelet Count; D011379:Prognosis; D011516:Prothrombin / Q000032:analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D011516:Prothrombin; D001219:Aspartate Aminotransferases