A comparison of four fibrosis indexes in chronic HCV: development of new fibrosis-cirrhosis index (FCI)

Abstract

Background: Hepatitis C can lead to liver fibrosis and cirrhosis. We compared readily available non-invasive fibrosis indexes for the fibrosis progression discrimination to find a better combination of existing non-invasive markers.

Methods: We studied 157 HCV infected patients who underwent liver biopsy. In order to differentiate HCV fibrosis progression, readily available AAR, APRI, FI and FIB-4 serum indexes were tested in the patients. We derived a new fibrosis-cirrhosis index (FCI) comprised of ALP, bilirubin, serum albumin and platelet count. FCI = [(ALP × Bilirubin) / (Albumin × Platelet count)].

Results: Already established serum indexes AAR, APRI, FI and FIB-4 were able to stage liver fibrosis with correlation coefficient indexes 0.130, 0.444, 0.578 and 0.494, respectively. Our new fibrosis cirrhosis index FCI significantly correlated with the histological fibrosis stages F0-F1, F2-F3 and F4 (r = 0.818, p < 0.05) with AUROCs 0.932 and 0.996, respectively. The sensitivity and PPV of FCI at a cutoff value < 0.130 for predicting fibrosis stage F0-F1 was 81% and 82%, respectively with AUROC 0.932. Corresponding value of FCI at a cutoff value ≥1.25 for the prediction of cirrhosis was 86% and 100%.

Conclusions: The fibrosis-cirrhosis index (FCI) accurately predicted fibrosis stages in HCV infected patients and seems more efficient than frequently used serum indexes.

Figure 1

Box plots of the AAR, APRI, FIB-4 and FI for different fibrosis stages. The horizontal line inside each box represents the median, while the top and bottom of boxes represent the 25^th and 75^th percentiles, respectively. Vertical lines from the ends of the box encompass the extreme data points.

Figure 2

Receiver operating characteristic curves generated by four serum markers, AAR, APRI, FIB-4 and FI for differentiation between patients in fibrosis stage F0-F1, F2-F3 and F4.

Figure 3

Relationship between fibrosis stages and the ALP, bilirubin, serum albumin and fibrosis-cirrhosis index (FCI). The lines through the middle of the boxes represent the median, while the top and bottom of the boxes are the 25^th and 75^th percentiles. The error bars represent measurement range (maximum and minimum values).

Figure 4

Receiver operating characteristic curves for individual serum markers; ALP, bilirubin, platelet count and serum albumin for the predication of F0-F1, F2-F3 and F4 fibrosis stages.

Figure 5

Box plot of fibrosis-cirrhosis index (FCI) for each fibrosis stage. The horizontal line inside each box represents the median, while the top and bottom of boxes represent the 25^th and 75^th percentiles, respectively. Vertical lines from the ends of the box encompass the extreme data points.

Figure 6

Receiver operating characteristic curves generated by the fibrosis-cirrhosis index (FCI) to discriminate fibrosis stages F0-F1 and F4. FCI showed maximum AUC for prediction of F4 (cirrhosis).