[Utility of 2 biochemical models predictive of liver fibrosis grade in prison inmates with hepatitis C].
OBJECTIVE
To evaluate the utility of two biochemical tests (APRI and FIB-4) to predict liver fibrosis (LF) in prison inmates with chronic hepatitis C.


METHODS
We performed a cross-sectional study in 165 inmates with chronic hepatitis C and liver biopsy from two Spanish prisons. LF was staged according to the Metavir Index and was subsequently reclassified as mild or absent (LF<or=1), significant (LF>or=2) or serious (LF>or=3). APRI and FIB-4 were calculated in all patients. The predictive value was calculated by the area under the curve and the optimal cut-off was obtained based on the best specificity value for each LF stage. Then, we analyzed the sensitivity, positive predictive value (PPV) and negative predictive value (NPV) for each cut-off point.


RESULTS
LF<or=1 was found in 116 inmates (80.3%), significant LF in 49 (29.3%) and serious LF in 24 (14.5%). An APRI value >or=0.55 or FIB-4 >or=1.0 showed a PPV of 91% and 92%, respectively, for the presence of any grade of LF (>or=1), but both tests had low diagnostic sensitivity: 61.8% and 61.1%, respectively. An APRI value >or=0.86 or FIB-4 >or=1.3 showed a high NPV for serious LF (92.5% and 88.4% respectively).


CONCLUSIONS
Both tests have a high predictive capacity to detect the presence of LF in inmates with chronic hepatitis C, but their predictive value in detecting intermediate stages of LF is low. Moreover, a significant number of inmates with LF are not identified.
Portilla
Joaquín
J
Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Alicante, España. portilla_joa@gva.es
López-Burgos
Antonio
A
Saiz-De-La-Hoya-Zamácola
Pablo
P
Sánchez-Payá
José
J
Bedía-Collantes
Miguel
M
Faraco-Atienzar
Inmaculada
I
Lissen
Eduardo
E
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D003430:Cross-Sectional Studies; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000453:epidemiology; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D011329:Prisoners; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000453:epidemiology
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase