title: Modeling hepatic fibrosis in African American and Caucasian American patients with chronic hepatitis C virus infection.
abstract: Assessment of histological stage is an integral part of disease management in patients infected with the hepatitis C virus (HCV). The aim of this study was to develop a model incorporating objective clinical and laboratory parameters to estimate the probability of severe fibrosis (i.e., Ishak fibrosis > or = 3) in previously untreated African American (AA) and Caucasian American (CA) patients with HCV genotype 1. The Ishak fibrosis scores of 205 CA and 194 AA patients enrolled in the Viral Resistance to Antiviral Therapy of Chronic Hepatitis C study (Virahep-C) were modeled using simple and multiple logistic regression. The model was then validated in an independent cohort of 461 previously untreated patients with HCV. The distribution of fibrosis scores was similar in the AA and CA patients as was the proportion of patients with severe fibrosis (35% vs. 39%, P = .47). After accounting for the number of portal areas in the biopsy, patient age, serum aspartate aminotransferase, alkaline phosphatase, and platelet count were independently associated with severe fibrosis in the overall cohort, and the relationship with fibrosis was similar in both the AA and CA subgroups. The area under the receiver operating characteristic curve (AUROC) of the Virahep-C model (0.837) was significantly better than in other published models (P = .0003). The AUROC of the Virahep-C model was 0.851 in the validation population. In conclusion, a model consisting of widely available clinical and laboratory features predicted severe hepatic fibrosis equally well in AA and CA patients with HCV genotype 1 and was superior to other published models. The excellent performance of the Virahep-C model in an external validation cohort suggests the findings are replicable and potentially generalizable.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. rfontana@umich.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fontana
authors.forename: David E
authors.initials: DE
authors.lastname: Kleiner
authors.forename: Richard
authors.initials: R
authors.lastname: Bilonick
authors.forename: Norah
authors.initials: N
authors.lastname: Terrault
authors.forename: Nezam
authors.initials: N
authors.lastname: Afdhal
authors.forename: Steven H
authors.initials: SH
authors.lastname: Belle
authors.forename: Lennox J
authors.initials: LJ
authors.lastname: Jeffers
authors.forename: Darmendra
authors.initials: D
authors.lastname: Ramcharran
authors.forename: Marc G
authors.initials: MG
authors.lastname: Ghany
authors.forename: Jay H
authors.initials: JH
authors.lastname: Hoofnagle
mesh_terms: D001741:Black or African American; D000704:Analysis of Variance; D019540:Area Under Curve; D001706:Biopsy; D016174:Hepacivirus / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000208:ethnology* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000208:ethnology* / Q000209:etiology; D016015:Logistic Models; D015999:Multivariate Analysis; D012313:RNA / Q000032:analysis; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D044465:White People
chemical_list: D012313:RNA