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- Title
Noninvasive Serum Fibrosis Markers for Screening and Staging Chronic Hepatitis C Virus Patients in a Large US Cohort.
- Authors
Holmberg, Scott D.; Lu, Mei; Rupp, Loralee B.; Lamerato, Lois E.; Moorman, Anne C.; Vijayadeva, Vinutha; Boscarino, Joseph A.; Henkle, Emily M.; Gordon, Stuart C.
- Abstract
Authors review 2 (FIB-4 and APRI) systems relying on more easily obtainable serum and cell biomarkers for liver biopsies to stage liver disease. This would be an important step in opening treatment and care of uncomplicated hepatitis C virus–infected patients.Background. Liver biopsy remains critical for staging liver disease in hepatitis C virus (HCV)–infected persons, but is a bottleneck to evaluation, follow-up, and treatment of HCV. Our analysis sought to validate APRI (aspartate aminotransferase [AST]–to-platelet ratio index) and FIB-4, an index from serum fibrosis markers (alanine aminotransferase [ALT], AST, and platelets plus patient age) to stage liver disease.Methods. Biopsy results from HCV patients in the Chronic Hepatitis Cohort Study were mapped to an F0–F4 equivalent scale; APRI and FIB-4 scores at the time of biopsy were then mapped to the same scale.Results. We identified 2372 liver biopsies from HCV-infected patients with contemporaneous laboratory values for imputing APRI and FIB-4. Fibrosis stage distributions by the equivalent biopsy scale were 267 (11%) F0; 555 (23%) F1; 648 (27%) F2; 394 (17%) F3; and 508 (21%) F4. Mean APRI and FIB-4 values significantly increased with successive fibrosis levels (P < .05). The areas under the receiver operating characteristic curve (AUROC) analysis distinguishing severe (F3–F4) from mild-to-moderate fibrosis (F0–F2) were 0.80 (95% confidence interval [CI], .78–.82) for APRI and 0.83 (95% CI, .81–.85) for FIB-4. There was a significant difference between the AUROCs of FIB-4 and APRI (P < .001); 88% of persons who had a FIB-4 score ≥2.0 were at stage F2 or higher.Conclusions. In a large observational cohort, FIB-4 was good at differentiating 5 stages of chronic HCV infection. It can be useful in screening patients who need biopsy and therapy, for monitoring patients with less advanced disease, and for longitudinal studies.
- Subjects
UNITED States; CHRONIC hepatitis C; SERUM; FIBROSIS; LIVER biopsy; BIOMARKERS; ALANINE aminotransferase; LIVER disease diagnosis; DISEASE progression; COHORT analysis
- Publication
Clinical Infectious Diseases, 2013, Vol 57, Issue 2, p240
- ISSN
1058-4838
- Publication type
Article