title: Usefulness of indirect noninvasive methods in predicting progression to cirrhosis in chronic hepatitis C.
abstract: OBJECTIVE
  The ability of noninvasive methods to predict the development of cirrhosis has not been established. We evaluated the ability of three noninvasive methods [the Forns index, the aspartate aminotransferase-to-platelet ratio index (APRI), and the Non-Invasive Hepatitis-C-related Cirrhosis Early Detection (NIHCED) score] to determine the risk of developing cirrhosis in chronic hepatitis C.
  
  
  METHODS
  Consecutive patients with chronic hepatitis C who had undergone liver biopsy between 1998 and 2004 were eligible. We used the three methods to evaluate patients at baseline and at follow-up (4-10 years later). When these methods yielded discordant or indeterminate results, a second liver biopsy was performed. Logistic regression models were fitted for each method to predict whether cirrhosis would appear and to predict long-term mortality from cirrhosis.
  
  
  RESULTS
  We included 289 patients in our study. The mean scores at baseline and at follow-up, respectively, were as follows: Forns, 5.47 ± 1.95 and 6.56 ± 2.02; APRI, 1.1 ± 2.33 and 1.4 ± 1.53; and NIHCED, 7.79 ± 11.45 and 15.48 ± 15.28. The area under the receiver operating characteristic curve for predicting cirrhosis was 0.83 for Forns, 0.79 for APRI, and 0.76 for NIHCED. The sensitivity and specificity for predicting cirrhosis, respectively, were 75 and 71% for Forns (cutoff 4.7), 86 and 42% for APRI (cutoff 0.48), and 41 and 82% for NIHCED (cutoff 0). The area under the receiver operating characteristic curve for predicting mortality was 0.86 for Forns, 0.79 for APRI, and 0.84 for NIHCED.
  
  
  CONCLUSIONS
  Indirect noninvasive markers could help identify patients with chronic hepatitis C at risk of progression to cirrhosis.
authors.affiliation: aHepatology Unit, Digestive Disease System, Sabadell's Hospital bDay Hospital, Digestive Disease System, Sabadell's Hospital Departments of cRadiology dPathology, UDIAT-CD, Sabadell's Hospital, Universitat Autònoma de Barcelona, Sabadell eDepartment of Applied Statistics, Universitat Autònoma de Barcelona, Bellatera, Barcelona fCIBERehd, Health Institute Carlos III, Madrid, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Vergara
authors.forename: Guillermina
authors.initials: G
authors.lastname: Bejarano
authors.forename: Blai
authors.initials: B
authors.lastname: Dalmau
authors.forename: Montserrat
authors.initials: M
authors.lastname: Gil
authors.forename: Mireia
authors.initials: M
authors.lastname: Miquel
authors.forename: Jordi
authors.initials: J
authors.lastname: Sanchez-Delgado
authors.forename: Meritxell
authors.initials: M
authors.lastname: Casas
authors.forename: Jordi
authors.initials: J
authors.lastname: Puig
authors.forename: Eva
authors.initials: E
authors.lastname: Martinez-Bauer
authors.forename: Angelina
authors.initials: A
authors.lastname: Dosal
authors.forename: Maria
authors.initials: M
authors.lastname: Lopez
authors.forename: Laura
authors.initials: L
authors.lastname: Moreno
authors.forename: Oliver
authors.initials: O
authors.lastname: Valero
authors.forename: Maria-Rosa
authors.initials: MR
authors.lastname: Bella
authors.forename: Xavier
authors.initials: X
authors.lastname: Calvet
mesh_terms: D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013030:Spain; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D015415:Biomarkers; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases