title: Validation of hepascore, compared with simple indices of fibrosis, in patients with chronic hepatitis C virus infection in United States.
abstract: OBJECTIVE
  Biomarkers are being developed as alternatives to liver biopsy for predicting liver fibrosis in patients with chronic hepatitis C. Hepascore uses noninvasive serum markers and has been validated in Australian and European populations for predicting different degrees of fibrosis. This study validated this test in a U.S. population.
  
  
  METHODS
  Patients with chronic hepatitis C virus infection were assigned to training (n = 203) or validation (n = 188) sets. Liver fibrosis was staged according to the METAVIR scoring system. The Hepascore algorithm uses data on age, sex, as well as total bilirubin, gamma-glutamyl transferase, alpha2-macroglobulin, and hyaluronic acid levels.
  
  
  RESULTS
  The ability of Hepascore to predict significant fibrosis (F2-4) as determined by the area under the receiver operating curve was similar in training (0.83) and validation sets (0.81) and was comparable to results seen in previous studies. A cutoff score of > or =0.55 was best for predicting significant fibrosis, with a sensitivity and specificity of 82% and 65% and positive and negative predictive values of 70% and 78%. When compared with 2 simple indices, FIB-4 (age, platelets, AST, and ALT) and APRI (AST/platelet ratio index), Hepascore performed better at excluding advanced fibrosis by using a low cutoff score but worse at predicting fibrosis by using a high cutoff score. An algorithm with Hepascore followed by FIB-4 or APRI spared 103 of 391 individuals a liver biopsy and missed advanced fibrosis in only 1 patient.
  
  
  CONCLUSIONS
  Hepascore accurately predicted likelihood of developing fibrosis and could alleviate the need for liver biopsy in a subset of patients.
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Laren
authors.initials: L
authors.lastname: Becker
authors.forename: Wael
authors.initials: W
authors.lastname: Salameh
authors.forename: Anthony
authors.initials: A
authors.lastname: Sferruzza
authors.forename: Ke
authors.initials: K
authors.lastname: Zhang
authors.forename: Ro
authors.initials: R
authors.lastname: ng Chen
authors.forename: Raza
authors.initials: R
authors.lastname: Malik
authors.forename: Richard
authors.initials: R
authors.lastname: Reitz
authors.forename: Imad
authors.initials: I
authors.lastname: Nasser
authors.forename: Nezam H
authors.initials: NH
authors.lastname: Afdhal
mesh_terms: D000328:Adult; D000367:Age Factors; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D044967:Serum / Q000737:chemistry; D012720:Severity of Illness Index; D012737:Sex Factors; D014481:United States; D000511:alpha-Macroglobulins / Q000032:analysis; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D015415:Biomarkers; D000511:alpha-Macroglobulins; D006820:Hyaluronic Acid; D005723:gamma-Glutamyltransferase; D001663:Bilirubin