FibroScore for the non-invasive assessment of liver fibrosis in chronic viral hepatitis.
OBJECTIVE
To evaluate the predictive value of a set of laboratory markers for the assessment of liver fibrosis in chronic viral hepatitis patients.


METHODS
Cross-sectional study.


METHODS
Baqai Medical University, Combined Military Hospital, Malir, Karachi, from November 2006 to May 2008.


METHODS
Twenty laboratory parameters were measured in 100 treatment-naïve chronic viral hepatitis patients who also had liver biopsy performed. Descriptive statistics, areas under the ROC's curves, and multivariate logistic regression analysis identified a fibrosis panel, a set of five most useful markers, for the assessment of stages of fibrosis, stage 0 to stage 4. The fibrosis index, FibroScore, consisted of bilirubin, Gamma glutamyl transferase, Hyaluronic acid, alpha 2 macroglobulin, and platelets evaluation.


RESULTS
A score of ≥ 0.5 predicted stages 2, 3 and 4, with a sensitivity of 82%, and specificity of 92%. A score ≥ 0.5 for stages 3 and 4 had a sensitivity of 85%, and specificity of 89%. At a score of > 0.80, for stages 3 and 4, the sensitivity was 70%, specificity was 97%, and PPV 87% (there was ≥ 85% possibility of presence of stage 3 or 4). A score of ≤ 0.20 predicted the absence of stages 2, 3, and 4 with a sensitivity of 91%, specificity of 86%, and NPV of 96%. Scores from 0.00 to 0.10 almost certainly ruled out the presence of stages 2-4 (NPV=98%). The areas under the ROC curve were: 0.808 for stage 2; 0.938 for stage 3; and 0.959 for stage 4.


CONCLUSIONS
A combination of 5 markers is very useful in predicting various stages of liver fibrosis, and is helpful in the non-invasive assessment of liver fibrosis in chronic viral hepatitis patients.
Department of Medicine, Gastroenterology, Military Hospital, Rawalpindi, Pakistan. shahzad_ashraf1@yahoo.com
Shahzad
S
Ashraf
Syed Azhar
SA
Ahmed
Jameel
J
Ahmed
Nadir
N
Ali
D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D001707:Biopsy, Needle; D001774:Blood Chemical Analysis; D003430:Cross-Sectional Studies; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology*; D008111:Liver Function Tests / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult; D000511:alpha-Macroglobulins / Q000032:analysis
D015415:Biomarkers; D000511:alpha-Macroglobulins; D001219:Aspartate Aminotransferases; D001663:Bilirubin