title: Comparing Child-Pugh, MELD, and FIB-4 to Predict Clinical Outcomes in Hepatitis C Virus-Infected Persons: Results From ERCHIVES.
abstract: BACKGROUND
  Identifying hepatitis C virus (HCV)-positive persons at high risk of early complications can help prioritize treatment decisions. We conducted this study to compare Child-Turcotte-Pugh (CP), MELD, and FIB-4 scores for predicting clinical outcomes and to identify those at low risk of complications.
  
  
  METHODS
  Within electronically retrieved cohort of HCV-infected veterans, we identified HCV-positive persons and excluded those with human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), prevalent hepatic decompensation (HD), hepatocellular carcinoma (HCC), and those treated for HCV. We calculated incidence rates for HD, HCC, and all-cause mortality at 1, 3, and 5 years after HCV diagnosis. Using receiver operating characteristic (ROC) curves, we determined the optimal cut-off values for each score for these outcomes.
  
  
  RESULTS
  Among 21 116 persons evaluated, 89.7% were CP Class-A, 79.9% had MELD<9, and 43.4% had FIB-4<1.45. AUROC for HD at 1, 3, and 5 years was higher for FIB-4 (0.84-0.86) compared with MELD (0.70-0.76) (P < .001). AUROC for HCC at 1, 3, and 5 years was 0.81-0.82 for FIB-4 but 0.61-0.68 for CP and MELD scores. (P < .001) AUROC for all-cause mortality at 3 and 5 years was 0.65-0.68. The optimal cut-off scores to identify persons at low risk of complications were as follows: CP <5; MELD <8; FIB-4 <3 for HD and HCC, and <2 for all-cause mortality, below which <1.5% developed HD and HCC and ≤2.5% died at 3 years.
  
  
  CONCLUSIONS
  FIB-4 score is a better predictor of HD and HCC in HCV-positive persons. A score of <3 is associated with a low risk of HD and HCC 1 and 3 years after HCV diagnosis.
authors.affiliation: VA Pittsburgh Healthcare System, Pennsylvania.|Weill Cornell Medical College, Doha, Qatar, and New York, New York.|Hamad Healthcare Quality Institute and Hamad Medical Corporation, Doha, Qatar.
authors.forename: Adeel A
authors.initials: AA
authors.lastname: Butt
authors.affiliation: VA Pittsburgh Healthcare System, Pennsylvania.
authors.forename: Yanjie
authors.initials: Y
authors.lastname: Ren
authors.affiliation: University of Pennsylvania, Perelman School of Medicine, Philadelphia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lo Re
authors.affiliation: VA Connecticut Healthcare System, West Haven.|Division of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Tamar H
authors.initials: TH
authors.lastname: Taddei
authors.affiliation: Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.
authors.forename: David E
authors.initials: DE
authors.lastname: Kaplan
mesh_terms: D015331:Cohort Studies; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: ERCHIVES; HCV; mortality; outcomes; treatment