title: A simple noninvasive index to predict significant liver fibrosis in patients with advanced schistosomiasis japonica.
abstract: BACKGROUND
  Schistosoma japonicum causes marked liver fibrosis, while lethal syndromes present in advanced schistosomiasis patients. Its management depends on the degree of fibrosis present.
  
  
  METHODS
  Fifty-two patients were recruited to assess the diagnostic value of bio-markers in patients with advanced schistosomiasis japonica. Fibrosis was assessed in liver biopsies using METAVIR system. The correlation between conventional parameters and significant fibrosis (F2-F4) was assessed using univariate analysis and logistic regression. The method of area under receiver operating characteristic curves (AUROCs) was used as a measurement of diagnostic efficacy.
  
  
  RESULTS
  White blood cell counts, platelet counts and albumin (all P<0.05) were significantly lower, while prothrombin time, international normalized ratio (INR), hyaluronic acid (HA), IV collagen and ultrasound fibrosis scores (all P<0.01) were significantly elevated in F2-F4 patients compared with F0-F1 patients. HA and INR were identified as independent predictors by multivariate analysis (P=0.023 and P=0.013, respectively). Of the routine laboratory tests for the diagnosis of significant fibrosis, HA gave the best AUROC of 0.875 (95% confidence interval (CI): 0.701-0.997). We constructed a new simple index (INR×HA/100) to discriminate between F2-F4 patients and F0-F1 patients. It showed the highest AUROC of 0.921 (95% CI: 0.828-1.000), and had better diagnostic values than APRI and FIB-4.
  
  
  CONCLUSIONS
  HA and INR were reliable markers for differentiating significant liver fibrosis in patients with advanced schistosomiasis japonica. And the new simple index can easily predict significant liver fibrosis with a high degree of accuracy.
authors: Department of Schistosomiasis japonica, Jiaxing First Hospital, Zhejiang, People's Republic of China.
authors: Yi-ming
authors: YM
authors: Wu
authors: Nuo
authors: N
authors: Xu
authors: Jie-yun
authors: JY
authors: Hu
authors: Xiao-fei
authors: XF
authors: Xu
authors: Wan-xin
authors: WX
authors: Wu
authors: Shu-xing
authors: SX
authors: Gao
authors: Wen-jun
authors: WJ
authors: Zhu
authors: Wen-lin
authors: WL
authors: Wu
authors: Xi-zhong
authors: XZ
authors: Shen
authors: Ji-yao
authors: JY
authors: Wang
authors: Sheng-di
authors: SD
authors: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003710:Demography; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000032:analysis; D019934:International Normalized Ratio; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D012549:Schistosoma japonicum / Q000502:physiology*; D012554:Schistosomiasis japonica / Q000150:complications* / Q000175:diagnosis; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D006820:Hyaluronic Acid