Markers Accurate in Detecting Cirrhosis in Patients with HCV

Issue: December 2014

PHILADELPHIA — Multiple noninvasive markers, including aminotransferase to platelet ratio index and Göteborg University Cirrhosis Index scores, were accurate in predicting cirrhosis, according to data presented at the ACG Annual Scientific Meeting.

“How much do routine blood tests tell us about liver fibrosis?” Ragesh B. Thandassery, MD, DM, division of gastroenterology, Hamad Medical Corporation, Doha, Qatar, said during his presentation. “Most of the noninvasive markers for liver fibrosis which are being mentioned today can derive from simple routine blood tests that we do day-in and day-out for our patients with chronic liver disease; almost all these tests are based on simple blood tests.”

The aim of this study was to compare these simple noninvasive markers of liver fibrosis to determine the diagnosis accuracy against cirrhosis, advanced fibrosis and significant fibrosis, Thandassery said.

Researchers analyzed liver biopsies from 1,602 patients with hepatitis C virus infection after comparing them with the following noninvasive markers: aminotransferase to platelet ratio index (APRI), Fibrosis-4, Lok score, Göteborg University Cirrhosis Index (GUCI) score, Fibro-Q score and Fibrosis cirrhosis index. In addition, liver fibrosis scores were compared with three new markers: mean platelet volume, red cell distribution width/platelet count ratio and globulin/platelet count index. The mean age of all the patients was 41.8±9.6 years. A majority of patients had stage 2 fibrosis (39.5%); 1.9% had stage 0, 32.9% had stage 1, 19% had stage 3 and 6.6% had stage 4.

Using area under the receiver operating curve (AUROC), GUCI score had the highest predictive accuracy for cirrhosis (AUROC= 0.910; 95% CI, 0.853-0.967) followed by APRI score (AUROC= 0.910; 95% CI, 0.853-0.965). Of the new scores, globulin/platelet count index was found to be a high predictor for cirrhosis (AUROC=0.857; 95% CI, 0.772-0.941). King’s score had the highest predictive accuracy for all stages of fibrosis except stages 0 and 1 (AUROC=0.908; 95% CI, 0.857-0.958).

“For dictating cirrhosis and advanced fibrosis, these noninvasive markers do pretty well, in fact for cirrhosis, the GUCI score and APRI score did best,” Thandassery said. “When it comes to significant fibrosis or lower fibrosis, these noninvasive scores do not do as well, so the real challenge today is to have better noninvasive markers to predict various degrees of fibrosis.”

For more information:

Thandassery RB. Abstract 30. Presented at: Annual ACG Scientific Meeting, Oct. 17-22, 2014; Philadelphia, PA.

Disclosure: The researchers report no relevant financial disclosures.