A novel fibrosis index comprising a non-cholesterol sterol accurately predicts HCV-related liver cirrhosis.
Diagnosis of liver cirrhosis is essential in the management of chronic hepatitis C virus (HCV) infection. Liver biopsy is invasive and thus entails a risk of complications as well as a potential risk of sampling error. Therefore, non-invasive diagnostic tools are preferential. The aim of the present study was to create a model for accurate prediction of liver cirrhosis based on patient characteristics and biomarkers of liver fibrosis, including a panel of non-cholesterol sterols reflecting cholesterol synthesis and absorption and secretion. We evaluated variables with potential predictive significance for liver fibrosis in 278 patients originally included in a multicenter phase III treatment trial for chronic HCV infection. A stepwise multivariate logistic model selection was performed with liver cirrhosis, defined as Ishak fibrosis stage 5-6, as the outcome variable. A new index, referred to as Nordic Liver Index (NoLI) in the paper, was based on the model: Log-odds (predicting cirrhosis) = -12.17+ (age × 0.11) + (BMI (kg/m(2)) × 0.23) + (D7-lathosterol (μg/100 mg cholesterol)×(-0.013)) + (Platelet count (x10(9)/L) × (-0.018)) + (Prothrombin-INR × 3.69). The area under the ROC curve (AUROC) for prediction of cirrhosis was 0.91 (95% CI 0.86-0.96). The index was validated in a separate cohort of 83 patients and the AUROC for this cohort was similar (0.90; 95% CI: 0.82-0.98). In conclusion, the new index may complement other methods in diagnosing cirrhosis in patients with chronic HCV infection.
Department of Infectious Diseases/Virology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
Magdalena
M
Ydreborg
Department of Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden.
Vera
V
Lisovskaja
Department of Infectious Diseases/Virology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
Martin
M
Lagging
Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
Peer
P
Brehm Christensen
Department of Clinical Science, University of Bergen, Bergen, Norway.
Nina
N
Langeland
Department of Infectious Diseases, Aarhus University, Aarhus, Denmark.
Mads Rauning
MR
Buhl
Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
Court
C
Pedersen
Department of Clinical Science, University of Bergen, Bergen, Norway.
Kristine
K
Mørch
Department of Infectious Diseases/Virology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
Rune
R
Wejstål
Department of Infectious Diseases/Virology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
Gunnar
G
Norkrans
Department of Infectious Diseases/Virology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
Magnus
M
Lindh
Institute of Clinical Medicine, Department of Gastroenterology, Helsinki University, Helsinki, Finland.
Martti
M
Färkkilä
Department of Infectious Diseases/Virology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
Johan
J
Westin
D015415:Biomarkers / Q000097:blood; D005260:Female; D006526:Hepatitis C / Q000150:complications* / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013261:Sterols / Q000378:metabolism*
D015415:Biomarkers; D013261:Sterols