Noninvasive ratio indexes to evaluate fibrosis staging in chronic hepatitis C: role of platelet count/spleen diameter ratio index.
OBJECTIVE
Noninvasive evaluation of fibrosis is an on-going effort in the management of chronic hepatitis C. This study was planned to noninvasively evaluate fibrosis staging.


METHODS
We evaluated the biochemical, functional [aminopyrine breath test (ABT)] and ultrasonographic variables of 75 chronic hepatitis C patients.


RESULTS
Clinical [body mass index (BMI)], biochemical [aspartate aminotransferase (AST), alanine aminotransferase (ALT) and platelets (PLT)] and ratio indexes, together with the ABT, showed a higher relationship with fibrosis: initial (score<or=2) versus evident (score>2) fibrosis: BMI (24+/-2 vs. 26+/-2, P=0.0007), AST (56+/-36 vs. 88+/-65, P=0.0159), ALT (92+/-54 vs. 139+/-108, P=0.0290), PLT (220+/-64 vs. 173+/-61, P=0.0007), PLT/spleen diameter ratio (PLT/SPD) (2133+/-786 vs. 1540+/-681, P=0.0003), AST/platelet count ratio index (APRI) (0.80+/-0.87 vs. 1.51+/-1.47, P=0.0010), ABT%d/h30 min (10.8+/-4.5 vs. 7.6+/-3.8, P=0.0007), ABT%d/cum120 min (8.9+/-3.3 vs. 6.5+/-3.1, P=0.0007). Considering the differences between fibrosis score 2 and 3 patients, BMI, ABT and PLT/SPD ratio proved to be statistically significant. Multivariate stepwise analysis (with and without BMI) identified two models for distinguishing between initial and evident fibrosis: Model 1: -0.569+(BMIx0.107)+(APRIx0.169)-(PLT/SPDx0.304), and Model 2: 2.376+( APRIx0.152)-(ABTd/h30x0.043)-(PLT/SPDx0.249). These models showed concordance in identifying or ruling out evident fibrosis in 76% and 78.7% of the patients respectively. The PLT/SPD ratio also showed 78.7% concordance with the histological score.


CONCLUSIONS
These results suggest that noninvasive evaluation of fibrosis in chronic hepatitis C may be considered an effective tool thanks to the use of an inexpensive, reproducible ratio index.
Testa
R
R
Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy. rtesta@unige.it
Testa
E
E
Giannini
E
E
Borro
P
P
Milazzo
S
S
Isola
L
L
Ceppa
P
P
Lantieri
P B
PB
Risso
D
D
D000328:Adult; D000632:Aminopyrine / Q000032:analysis; D015415:Biomarkers / Q000032:analysis; D001944:Breath Tests; D005260:Female; D005355:Fibrosis; D019698:Hepatitis C, Chronic / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012372:ROC Curve; D013154:Spleen / Q000000981:diagnostic imaging; D018709:Statistics, Nonparametric; D014463:Ultrasonography
D015415:Biomarkers; D000632:Aminopyrine