title: Noninvasive estimation of liver fibrosis in biopsy-proven hepatitis C virus-infected patients: angiogenic fibrogenic link.
abstract: OBJECTIVE
  The assessment of liver fibrosis provides useful information not only for diagnosis but also for therapeutic decisions. This study aimed to develop and evaluate a predictive score named the angiogenic index (Angio-Index) for liver fibrosis staging and to compare Angio-Index by King, Gotebörg University Cirrhosis Index, Lok, FIB-4, and aspartate aminotranferase/alanine aminotranferase scores in hepatitis C virus-infected patients.
  
  
  METHODS
  Serum levels of angiopoietin-2, basic fibroblast growth factor, hepatocyte growth factor, and endostatin were assayed using an enzyme-linked immunosorbent assay in 122 HCV patients represented in two sets (estimation group and validation group). Stepwise linear discriminant analysis and area under receiver-operating characteristic curves (AUCs) were utilized to produce a predictive score comprising significant angiogenic biomarkers.
  
  
  RESULTS
  A novel score named the Angio-Index score was created on the basis of a combination of angiopoietin-2, basic fibroblast growth factor, hepatocyte growth factor, and endostatin. Angio-Index produces an AUC of 0.90 for significant fibrosis, 0.865 for advanced fibrosis, and 0.857 for cirrhosis. The Angio-Index score correctly classified 71% of the significant fibrosis (F2-F4) with a sensitivity of 93% and a specificity of 91%. The Angio-Index had a similar AUC in the validation study. The above six scores showed lower AUCs than Angio-Index.
  
  
  CONCLUSIONS
  Whereas liver biopsy is invasive, costly, and associated with complications, Angio-Index is simple, noninvasive, and more accurate; it may decrease the need for liver biopsy in Egyptian patients.
authors.affiliation: aChemistry Department, Damietta University, Damietta bEgyptian Liver Research Institute and Hospital cInternal Medicine Department, Faculty of Medicine, Mansoura Unversity, Mansoura dChemistry Department, Helwan University, Cairo, Egypt.
authors.forename: El-Shahat A
authors.initials: EA
authors.lastname: Toson
authors.forename: Gamal E
authors.initials: GE
authors.lastname: Shiha
authors.forename: Hatem A
authors.initials: HA
authors.lastname: El-Mezayen
authors.forename: Waleed
authors.initials: W
authors.lastname: Samir
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: El-Khininy
mesh_terms: D000328:Adult; D042702:Angiopoietin-2 / Q000097:blood*; D019540:Area Under Curve; D016002:Discriminant Analysis; D004534:Egypt; D043169:Endostatins / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D016222:Fibroblast Growth Factor 2 / Q000097:blood*; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000150:complications; D017228:Hepatocyte Growth Factor / Q000097:blood*; D006801:Humans; D016014:Linear Models; D008103:Liver Cirrhosis / Q000097:blood* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: C586513:ANGPT2 protein, human; D042702:Angiopoietin-2; D043169:Endostatins; C066855:HGF protein, human; D016222:Fibroblast Growth Factor 2; D017228:Hepatocyte Growth Factor