Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model

TLDR

Liver biopsy is the standard for staging fibrosis in chronic hepatitis C but is costly, risky, and poorly accepted. The study aimed to develop and validate a noninvasive predictive model to distinguish patients with significant fibrosis from those without. The authors analyzed clinical variables from 476 untreated chronic hepatitis C patients and built a scoring system using age, GGT, cholesterol, and platelet count. Multivariate analysis identified age, GGT, cholesterol, platelet count, and prothrombin time as independent predictors, and the resulting score achieved AUCs of 0.86 and 0.81 with a cutoff <4.2 yielding a 96 % negative predictive value, correctly excluding significant fibrosis in about one third of patients and misclassifying only two.

Abstract

Liver biopsy is required for staging hepatic fibrosis in patients with chronic hepatitis C, but it is an expensive procedure with occasional complications and poor patient acceptance. This cohort study was designed to assess the accuracy of a noninvasive method aimed to discriminate between patients with and without significant liver fibrosis (stages 2-4 versus 0-1). Clinically relevant variables were analyzed in a cohort of 476 consecutive untreated patients (estimation group, 351 patients; validation group, 125 patients) with chronic hepatitis C who underwent a liver biopsy. Multivariate analysis identified age, gamma glutamyl transpeptidase (GGT), cholesterol, platelet count, and prothrombin time as independent predictors of fibrosis. We constructed a model and a score system combining age, GGT, cholesterol, and platelet count that proved useful to identify patients without significant hepatic fibrosis. The area under the ROC curve was 0.86 for the estimation group and 0.81 for the validation group. Using the best cutoff score (less than 4.2), presence of significant fibrosis (F2 to F4) could be excluded with high accuracy (negative predictive value of 96%) in 125 (36%) of 351 patients. Similarly, it could be excluded with the same certainty in 49 (39%) of the 125 patients of the validation group. Only 2 patients with liver fibrosis stage 2 were incorrectly classified. In conclusion, a combination of easily accessible variables accurately predicts the absence of significant fibrosis and might render liver biopsy unnecessary in more than one third of patients with chronic hepatitis C.