title: Mean Platelet Volume, Red Cell Distribution Width to Platelet Count Ratio, Globulin Platelet Index, and 16 Other Indirect Noninvasive Fibrosis Scores: How Much Do Routine Blood Tests Tell About Liver Fibrosis in Chronic Hepatitis C?
abstract: Many indirect noninvasive scores to predict liver fibrosis are calculated from routine blood investigations. Only limited studies have compared their efficacy head to head. We aimed to compare these scores with liver biopsy fibrosis stages in patients with chronic hepatitis C.
  
  
  
  From blood investigations of 1602 patients with chronic hepatitis C who underwent a liver biopsy before initiation of antiviral treatment, 19 simple noninvasive scores were calculated. The area under the receiver operating characteristic curves and diagnostic accuracy of each of these scores were calculated (with reference to the Scheuer staging) and compared.
  
  
  
  The mean age of the patients was 41.8±9.6 years (1365 men). The most common genotype was genotype 4 (65.6%). Significant fibrosis, advanced fibrosis, and cirrhosis were seen in 65.1%, 25.6, and 6.6% of patients, respectively. All the scores except the aspartate transaminase (AST) alanine transaminase ratio, Pohl score, mean platelet volume, fibro-alpha, and red cell distribution width to platelet count ratio index showed high predictive accuracy for the stages of fibrosis. King's score (cutoff, 17.5) showed the highest predictive accuracy for significant and advanced fibrosis. King's score, Göteborg university cirrhosis index, APRI (the AST/platelet count ratio index), and Fibrosis-4 (FIB-4) had the highest predictive accuracy for cirrhosis, with the APRI (cutoff, 2) and FIB-4 (cutoff, 3.25) showing the highest diagnostic accuracy.We derived the study score 8.5 - 0.2(albumin, g/dL) +0.01(AST, IU/L) -0.02(platelet count, 10(9)/L), which at a cutoff of >4.7 had a predictive accuracy of 0.868 (95% confidence interval, 0.833-0.904) for cirrhosis.
  
  
  
  King's score for significant and advanced fibrosis and the APRI or FIB-4 score for cirrhosis could be the best simple indirect noninvasive scores.
authors.affiliation: Departments of *Medicine, Division of Gastroenterology and Hepatology †Laboratory Medicine and Pathology ‡Biostatistics, Hamad General Hospital, Doha, Qatar.
authors.forename: Ragesh B
authors.initials: RB
authors.lastname: Thandassery
authors.forename: Saad
authors.initials: S
authors.lastname: Al Kaabi
authors.forename: Madiha E
authors.initials: ME
authors.lastname: Soofi
authors.forename: Syed A
authors.initials: SA
authors.lastname: Mohiuddin
authors.forename: Anil K
authors.initials: AK
authors.lastname: John
authors.forename: Muneera
authors.initials: M
authors.lastname: Al Mohannadi
authors.forename: Khalid
authors.initials: K
authors.lastname: Al Ejji
authors.forename: Rafie
authors.initials: R
authors.lastname: Yakoob
authors.forename: Moutaz F
authors.initials: MF
authors.lastname: Derbala
authors.forename: Hamidullah
authors.initials: H
authors.lastname: Wani
authors.forename: Manik
authors.initials: M
authors.lastname: Sharma
authors.forename: Nazeeh
authors.initials: N
authors.lastname: Al Dweik
authors.forename: Mohammed T
authors.initials: MT
authors.lastname: Butt
authors.forename: Yasser M
authors.initials: YM
authors.lastname: Kamel
authors.forename: Khaleel
authors.initials: K
authors.lastname: Sultan
authors.forename: Fuad
authors.initials: F
authors.lastname: Pasic
authors.forename: Rajvir
authors.initials: R
authors.lastname: Singh
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D001792:Blood Platelets / Q000378:metabolism; D004909:Erythrocyte Indices; D005260:Female; D005838:Genotype; D005916:Globulins / Q000378:metabolism; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D008111:Liver Function Tests; D008297:Male; D063847:Mean Platelet Volume; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents; D005916:Globulins