title: The PAPAS index: a novel index for the prediction of hepatitis C-related fibrosis.
abstract: BACKGROUND
  Several noninvasive tests have been developed to determine the degree of hepatic fibrosis in patients with chronic hepatitis C (CHC) without performing liver biopsy.
  
  
  OBJECTIVE
  This study aimed to determine the performance of the PAPAS (Platelet/Age/Phosphatase/AFP/AST) index in patients with CHC for the prediction of significant fibrosis and cirrhosis and to compare it with other noninvasive tests. To date, no study has evaluated the application of the PAPAS index in CHC-associated liver fibrosis.
  
  
  METHODS
  This retrospective study included 137 consecutive patients with CHC who had undergone a percutaneous liver biopsy before treatment. The aspartate aminotransferase/platelet ratio (APRI), aspartate aminotransferase/alanine transaminase ratio (AAR), age-platelet index (API), FIB4, cirrhosis discriminate score (CDS), the Göteborg University cirrhosis index (GUCI), and PAPAS were calculated and compared with the diagnostic accuracies of all fibrosis indices between the groups F0-F2 (no-mild fibrosis) versus F3-F6 (significant fibrosis) and F0-F4 (no cirrhosis) versus F5-F6 (cirrhosis).
  
  
  RESULTS
  To predict significant fibrosis, the area under curve (95% confidence interval) for FIB4 was 0.727 followed by GUCI (0.721), PAPAS≈APRI≈CDS (0.716), and API (0.68). To predict cirrhosis, the area under curve (95% confidence interval) for FIB4 was calculated to be 0.735, followed by GUCI (0.723), PAPAS≈APRI≈CDS≈(0.71), and API (0.66). No statistically significant difference was observed among these predictors to exclude both significant fibrosis and cirrhosis (P>0.05).
  
  
  CONCLUSIONS
  The diagnostic capability of the PAPAS index has moderate efficiency and was not superior to other fibrosis markers for the identification of fibrosis in CHC patients. There is a need for more comprehensive prospective studies to help determine the diagnostic value of PAPAS for liver fibrosis.
authors.affiliation: Departments of aGastroenterology bPathology cPediatric Gastroenterology, Kayseri Training and Research Hospital dDepartment of Gastroenterology, Faculty of Medicine, Acibadem University eDepartment of Biostatistics, Erciyes University, Kayseri fDepartment of Gastroenterology, Faculty of Medicine, Firat University, Elazig, Turkey.
authors.forename: Banu D
authors.initials: BD
authors.lastname: Ozel
authors.forename: Orhan K
authors.initials: OK
authors.lastname: Poyrazoğlu
authors.forename: Ahmet
authors.initials: A
authors.lastname: Karaman
authors.forename: Hatice
authors.initials: H
authors.lastname: Karaman
authors.forename: Engin
authors.initials: E
authors.lastname: Altinkaya
authors.forename: Eylem
authors.initials: E
authors.lastname: Sevinç
authors.forename: Gökmen
authors.initials: G
authors.lastname: Zararsiz
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D004796:Clinical Enzyme Tests; D003661:Decision Support Techniques; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000821:virology*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014421:Turkey
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase