Accuracy of a predictive model for severe hepatic fibrosis or cirrhosis in chronic hepatitis C.
OBJECTIVE
To assess the accuracy of a model in diagnosing severe fibrosis/cirrhosis in chronic hepatitis C virus (HCV) infection.


METHODS
The model, based on the sequential combination of the Bonacini score (BS: ALT/AST ratio, platelet count and INR) and ultrasonography liver surface characteristics, was applied to 176 patients with chronic HCV infection. Assuming a pre-test probability of 35%, the model defined four levels of post-test probability of severe fibrosis/cirrhosis: <10% (low), 10-74% (not diagnostic), 75-90% (high) and >90% (almost absolute). The predicted probabilities were compared with the observed patientso distribution according to the histology (METAVIR).


RESULTS
Severe fibrosis/cirrhosis was found in 67 patients (38%). The model discriminated patients in three comparable groups: 34% with a very high (>90%) or low (<10%) probability of severe fibrosis, 33% with a probability ranging from 75% to 90%, and 33% with an uncertain diagnosis (i.e., a probability ranging from 10% to 74%). The observed frequency of severe fibrosis/cirrhosis was within the predefined ranges.


CONCLUSIONS
The model can correctly identify 67% of patients with a high (>75%) or low (<10%) probability of cirrhosis, leaving only 33% of the patients still requiring liver biopsy.
Colli
Agostino
A
Postgraduate School of Gastroenterology, Padiglione Granelli 3 piano, IRCCS -Ospedale Maggiore, Via F. Sforza 35, 20122 Milan, Italy.
Colucci
Alice
A
Paggi
Silvia
S
Fraquelli
Mirella
M
Massironi
Sara
S
Andreoletti
Marco
M
Michela
Vittorio
V
Conte
Dario
D
D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D019934:International Normalized Ratio; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D008954:Models, Biological; D010976:Platelet Count; D011237:Predictive Value of Tests; D014463:Ultrasonography
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase