title: Novel non-invasive biological predictive index for liver fibrosis in hepatitis C virus genotype 4 patients.
abstract: OBJECTIVE
  To investigate the diagnostic ability of a non-invasive biological marker to predict liver fibrosis in hepatitis C genotype 4 patients with high accuracy.
  
  
  METHODS
  A cohort of 332 patients infected with hepatitis C genotype 4 was included in this cross-sectional study. Fasting plasma glucose, insulin, C-peptide, and angiotensin-converting enzyme serum levels were measured. Insulin resistance was mathematically calculated using the homeostasis model of insulin resistance (HOMA-IR).
  
  
  RESULTS
  Fibrosis stages were distributed based on Metavir score as follows: F0 = 43, F1 = 136, F2 = 64, F3 = 45 and F4 = 44. Statistical analysis relied upon reclassification of fibrosis stages into mild fibrosis (F0-F) = 179, moderate fibrosis (F2) = 64, and advanced fibrosis (F3-F4) = 89. Univariate analysis indicated that age, log aspartate amino transaminase, log HOMA-IR and log platelet count were independent predictors of liver fibrosis stage (P< 0.0001). A stepwise multivariate discriminant functional analysis was used to drive a discriminative model for liver fibrosis. Our index used cut-off values of ≥ 0.86 and ≤ -0.31 to diagnose advanced and mild fibrosis, respectively, with receiving operating characteristics of 0.91 and 0.88, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ratio were: 73%, 91%, 75%, 90% and 8.0 respectively for advanced fibrosis, and 67%, 88%, 84%, 70% and 4.9, respectively, for mild fibrosis.
  
  
  CONCLUSIONS
  Our predictive model is easily available and reproducible, and predicted liver fibrosis with acceptable accuracy.
authors.affiliation: Mahmoud Khattab, Mohamed Abdel Fattah, Youssef Mousa, Elwy Soliman, Ibrahim Motawea, Department of Internal Medicine, Minia University, Minia 61111, Egypt.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Khattab
authors.affiliation: Mahmoud Khattab, Mohamed Abdel Fattah, Youssef Mousa, Elwy Soliman, Ibrahim Motawea, Department of Internal Medicine, Minia University, Minia 61111, Egypt.
authors.forename: Mohamed Amin
authors.initials: MA
authors.lastname: Sakr
authors.affiliation: Mahmoud Khattab, Mohamed Abdel Fattah, Youssef Mousa, Elwy Soliman, Ibrahim Motawea, Department of Internal Medicine, Minia University, Minia 61111, Egypt.
authors.forename: Mohamed Abdel
authors.initials: MA
authors.lastname: Fattah
authors.affiliation: Mahmoud Khattab, Mohamed Abdel Fattah, Youssef Mousa, Elwy Soliman, Ibrahim Motawea, Department of Internal Medicine, Minia University, Minia 61111, Egypt.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Mousa
authors.affiliation: Mahmoud Khattab, Mohamed Abdel Fattah, Youssef Mousa, Elwy Soliman, Ibrahim Motawea, Department of Internal Medicine, Minia University, Minia 61111, Egypt.
authors.forename: Elwy
authors.initials: E
authors.lastname: Soliman
authors.affiliation: Mahmoud Khattab, Mohamed Abdel Fattah, Youssef Mousa, Elwy Soliman, Ibrahim Motawea, Department of Internal Medicine, Minia University, Minia 61111, Egypt.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Breedy
authors.affiliation: Mahmoud Khattab, Mohamed Abdel Fattah, Youssef Mousa, Elwy Soliman, Ibrahim Motawea, Department of Internal Medicine, Minia University, Minia 61111, Egypt.
authors.forename: Mona
authors.initials: M
authors.lastname: Fathi
authors.affiliation: Mahmoud Khattab, Mohamed Abdel Fattah, Youssef Mousa, Elwy Soliman, Ibrahim Motawea, Department of Internal Medicine, Minia University, Minia 61111, Egypt.
authors.forename: Salwa
authors.initials: S
authors.lastname: Gaber
authors.affiliation: Mahmoud Khattab, Mohamed Abdel Fattah, Youssef Mousa, Elwy Soliman, Ibrahim Motawea, Department of Internal Medicine, Minia University, Minia 61111, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Altaweil
authors.affiliation: Mahmoud Khattab, Mohamed Abdel Fattah, Youssef Mousa, Elwy Soliman, Ibrahim Motawea, Department of Internal Medicine, Minia University, Minia 61111, Egypt.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Osman
authors.affiliation: Mahmoud Khattab, Mohamed Abdel Fattah, Youssef Mousa, Elwy Soliman, Ibrahim Motawea, Department of Internal Medicine, Minia University, Minia 61111, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hassouna
authors.affiliation: Mahmoud Khattab, Mohamed Abdel Fattah, Youssef Mousa, Elwy Soliman, Ibrahim Motawea, Department of Internal Medicine, Minia University, Minia 61111, Egypt.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Motawea
keywords: Age; Aspartate amino transaminase; Insulin resistance; Liver fibrosis; Platelets