title: Noninvasive markers of liver fibrosis are highly predictive of liver-related death in a cohort of HCV-infected individuals with and without HIV infection.
abstract: 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.
authors.affiliation: Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts 02118, USA. david.nunes@bmc.org
authors.forename: David
authors.initials: D
authors.lastname: Nunes
authors.forename: Catherine
authors.initials: C
authors.lastname: Fleming
authors.forename: Gwynneth
authors.initials: G
authors.lastname: Offner
authors.forename: Donald
authors.initials: D
authors.lastname: Craven
authors.forename: Oren
authors.initials: O
authors.lastname: Fix
authors.forename: Timothy
authors.initials: T
authors.lastname: Heeren
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Koziel
authors.forename: Camilla
authors.initials: C
authors.lastname: Graham
authors.forename: Sheila
authors.initials: S
authors.lastname: Tumilty
authors.forename: Paul
authors.initials: P
authors.lastname: Skolnik
authors.forename: Sherri
authors.initials: S
authors.lastname: Stuver
authors.forename: C Robert
authors.initials: CR
authors.lastname: Horsburgh
authors.forename: Deborah
authors.initials: D
authors.lastname: Cotton
mesh_terms: 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
chemical_list: D015415:Biomarkers