title: Non-invasive score system for fibrosis in chronic hepatitis: proposal for a model based on biochemical, FibroScan and ultrasound data.
abstract: OBJECTIVE
  We elaborate a non-invasive score system for liver fibrosis (NISF), exploring its diagnostic performance and comparing its accuracy to FibroScan in patients with chronic viral hepatitis (CH) and non-alcoholic fatty liver disease (NAFLD).
  
  
  METHODS
  Clinical, biochemical, elastographic and ultrasound parameters derived from patients with CH (n = 83) or NAFLD (n = 58), undergoing liver biopsy for fibrosis assessment, were prospectively collected as potential predictors of fibrosis. Each parameter was evaluated for its correlation with the liver biopsy (Gold Standard). Candidate predictors with good interobserver agreement and correlation with histological stages were combined into two algorithms (NISF) to predict fibrosis in chronic viral hepatitis and NAFLD.
  
  
  RESULTS
  The CH-NISF included six parameters: bluntness of liver edges, irregularity of left lobe surface, diameter of segment 4, liver stiffness measurement, platelet count and ALT values. The ability of the model to discriminate F3-F4 vs F0-F1 stages and F2 vs F0-F1 was high (AUROC of 0.95 and 0.83 respectively) and better than FibroScan alone, especially in intermediate stages (F2 vs F0-F1), AUROC 0.83 vs 0.57 (P = 0.003). The resulting algorithm is available as mathematical formula, nomogram or free online link. [http://health.mafservizi.it/NISF_Calculator/liver.htm] The NAFLD-NISF included liver stiffness, platelet count and AST levels, had good ability to discriminate F0-F1 vs F2-F3-F4 stages (AUROC 0.86), however, not significantly higher than FibroScan.
  
  
  CONCLUSIONS
  CH-NISF can be proposed as preliminary and easily available staging tool, superior to FibroScan alone in predicting histological fibrosis, especially in intermediate stages. Further validations are needed to improve NISF accuracy in NAFLD.
authors.affiliation: Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Gaia
authors.affiliation: Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Campion
authors.affiliation: Department of Epidemiology, Città della Salute e della Scienza - University Hospital, Turin, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Spandre
authors.affiliation: Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy.
authors.forename: Loretta
authors.initials: L
authors.lastname: Cosso
authors.affiliation: Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Brunello
authors.affiliation: Department of Epidemiology, Città della Salute e della Scienza - University Hospital, Turin, Italy.
authors.forename: Giovannino
authors.initials: G
authors.lastname: Ciccone
authors.affiliation: Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bugianesi
authors.affiliation: Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzetto
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D015331:Cohort Studies; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D019694:Hepatitis B, Chronic / Q000000981:diagnostic imaging / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000000981:diagnostic imaging / Q000473:pathology; D006525:Hepatitis, Viral, Human / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000000981:diagnostic imaging* / Q000473:pathology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler
keywords: FibroScan; NAFLD; chronic viral hepatitis; liver biopsy; non-invasive fibrosis; ultrasound scan