Noninvasive markers of liver fibrosis are highly predictive of liver-related death in a cohort of HCV-infected individuals with and without HIV infection.
OBJECTIVE
Noninvasive markers of liver fibrosis correlate with the stage of liver fibrosis, but have not been widely applied to predict liver-related mortality.


METHODS
We assessed the ability of two indices of liver fibrosis, aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and Fib-4, and two markers of extracellular matrix metabolism, hyaluronic acid (HA) and YKL40, to predict liver mortality in a prospective cohort of hepatitis C virus (HCV)-infected individuals with and without HIV coinfection. These were compared with two established prognostic scores, the Child-Pugh-Turcotte (CPT) and model of end-stage liver disease (MELD) scores.


RESULTS
A total of 303 subjects, of whom 207 were HIV positive at study entry, were followed up for a mean period of 3.1 years. There were 33 deaths due to liver disease. The ability of each test and score to predict 3-year liver mortality was expressed as the area under the receiver operator curve. The area under the receiver operator curve 95% confidence intervals were: HA 0.92 (0.86-0.96), CPT 0.91 (0.79-0.96), APRI 0.88 (0.80-0.93), Fib-4 0.87 (0.77-0.92), MELD 0.84 (71-0.91). In multivariate analyses HA, APRI, and fib-4 were independent predictors of mortality when included in models with MELD or CPT.


CONCLUSIONS
Noninvasive markers of liver fibrosis are highly predictive of liver outcome in HCV-infected individuals with and without HIV coinfection. These markers seem to have a prognostic value independent of CPT and MELD.
Nunes
David
D
Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts 02118, USA. david.nunes@bmc.org
Fleming
Catherine
C
Offner
Gwynneth
G
Craven
Donald
D
Fix
Oren
O
Heeren
Timothy
T
Koziel
Margaret J
MJ
Graham
Camilla
C
Tumilty
Sheila
S
Skolnik
Paul
P
Stuver
Sherri
S
Horsburgh
C Robert
CR
Cotton
Deborah
D
D000328:Adult; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006526:Hepatitis C / Q000097:blood / Q000150:complications / Q000401:mortality*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000821:virology; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index
D015415:Biomarkers