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Novel VAP fibrosis score superior to other noninvasive methods

New data showed that the VAP score — a novel noninvasive liver fibrosis staging model derived from aspartate aminotransferase, platelet count and von Willebrand factor antigen — outperformed other validated noninvasive methods among patients with chronic hepatitis C.

“Several noninvasive methods have been developed for liver fibrosis evaluation to minimize the usage of liver biopsy and its drawbacks,” Elham Ahmed Hassan, MD, from the Assiut University, Egypt, and colleagues wrote. “VAP could offer a useful strategy to stratify patients who would benefit from direct-acting antivirals, particularly in countries where recently developed methods for assessing liver fibrosis are not routinely available.”

Hassan and colleagues enrolled 127 treatment-naive patients with chronic hepatitis C in their study. Patients underwent abdominal ultrasonography and liver biopsy at baseline.

Researchers then evaluated the patients with the following noninvasive methods for comparison with biopsy: AST/alanine transaminase ratio (AAR), AST-to-platelet ratio (APRI), fibrosis-cirrhosis index (FCI), fibrosis index (FI), Fibrosis-4 score (FIB-4), fibrosis quotient (FibroQ), King score, and von Willebrand factor antigen (vWF-Ag)/thrombocyte ratio (VITRO) score.

AST (r = 0.42; P < .001), ALT (r = 0.315; P < .001), international normalized ratio (r = 0.419; P < .001), platelet count (r = –0.544; P < .001) and vWF-Ag (r = 0.555; P < .001) significantly correlated with various fibrosis stages.

After multivariable analysis, the researchers found that AST, platelet count and vWF-Ag correlated significantly with fibrosis stage 1, 2 and 3, and liver cirrhosis (P .05).

AST (AUROC = 0.713), platelet count (AUROC = 0.763) and vWF-Ag (AUROC = 0.769) demonstrated high diagnostic performance in predicting mild fibrosis. AST (AROC = 0.733), platelet count (AUROC = 0.732) and vWF-Ag (AUROC = 0.738) also showed high diagnostic power in predicting cirrhosis.

Compared with the noninvasive tests, the VAP score had the strongest correlation with histolic findings (r = 0.702; P < .0001), followed by VITRO (r = 0.62; P < .001) and APRI (r = 0.46; P < .001).

Similarly, the VAP score had the greatest predicting value for mild fibrosis (AUROC = 0.854), significant fibrosis (AUROC = 0.921), advanced fibrosis (AUROC = 0.849) and cirrhosis (AUROC = 0.861) compared with the other noninvasive scores (AUROC = 0.521-0.839).

In a validation group of 117 patients with matching characteristics, the researchers found that VAP remained a significant predictor for significant (AUROC = 0.902) and advanced fibrosis (AUROC = 0.822; P < .001) and cirrhosis (AUROC = 0.86; P < .003).

The researchers advise that the advantages of VAP are its superior diagnostic accuracy including early stages of fibrosis, its simplistic calculation, and its use of serum markers routinely obtained in clinic. However, as the researchers performed the study in a single center, further multicenter, prospective studies are warranted to confirm VAP’s predictive value. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.