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Non-Invasive Prediction of Hepatic Fibrosis in Patients With Chronic HCV Based on the Routine Pre-Treatment Workup


Marwa Khairy 1 , * , Mahassen Abdel-Rahman 1 , Maissa El-Raziky 1 , Wafaa El-Akel 1 , Naglaa Zayed 1 , Hany Khatab 2 , Gamal Esmat 1


1 Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, marwakhairy79@hotmail.com, Egypt

2 Pathology Department, Faculty of Medicine, Cairo University, Egypt


Hepatitis Monthly: 12 (11); 6718
Published Online: November 1, 2012
Article Type: Research Article
Received: June 9, 2012
Accepted: August 13, 2012




Background: Hepatic fibrosis is an inclusion indicator for treatment and a major independent predictor of treatment response in patients with chronic hepatitis C. Liver biopsy, considered as the gold standard for evaluating liver fibrosis, has carried some drawbacks. Currently used noninvasive predictors of fibrosis are considered less accurate than liver biopsy.

Objectives: Our aim was to assess noninvasive predictors of fibrosis in patients with chronic hepatitis C using the routine laboratory pre-treatment workup.

Patients and Methods: Cross sectional study including 4289 Egyptian patients with chronic hepatitis C were assessed for the need to interferon and ribavirin therapy. Routine pre-treatment workup and reference needle liver biopsy were performed. FIB-4 index, APRI and modified APRI scores were validated. Patients were divided into two groups, first with no or minimal fibrosis, and second with moderate and marked fibrosis using the Metavir score.

Results: Multivariate logistic regression analysis showed that age, body mass index, aspartate aminotransferase, alpha fetoprotein, platelets count, FIB-4 index, APRI and modified APRI score were significant independent predictors of fibrosis. Age > 43 years, aspartate aminotransferase > 47U/L, platelets < 205103/mm3, and alpha fetoprotein > 2.6 ng/ml had the highest cutoff points in receiver operator characteristic curves. Taking into account the four variables together; the presence of ? 2 variables is associated with moderate and advanced fibrosis with a sensitivity of 0.81, specificity of 0.5, positive predictive value of 0.53 and negative predictive value of 0.79. FIB-4 index represented the best performing receiver operator characteristic curve for diagnosing moderate and marked fibrosis among other independent factors with a sensitivity of 0.74, specificity of 0.6, positive predictive value of 0.56 and negative predictive value of 0.76.

Conclusions: Chronic HCV pre-treatment routine work up and composite fibrosis scores are good noninvasive predictor of liver fibrosis and can be used as an alternative method to invasive liver biopsy without adding more financial expenses to the treatment.


Hepatitis C Liver Cirrhosis Fibrosis

© 2012, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
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