Brief Article
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World J Gastroenterol. Dec 7, 2010; 16(45): 5710-5715
Published online Dec 7, 2010. doi: 10.3748/wjg.v16.i45.5710
Role of simple biomarkers in predicting fibrosis progression in HCV infection
Rajasekhara R Mummadi, John R Petersen, Shu-Yuan Xiao, Ned Snyder
Rajasekhara R Mummadi, Ned Snyder, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Texas Medical Branch, Houston, TX 77025, United States
John R Petersen, Shu-Yuan Xiao, Department of Pathology, University of Texas Medical Branch, Houston, TX 77025, United States
Ned Snyder, Department of Gastroenterology and Hepatology, Kelsey Seybold Clinic, 2727 W. Holcombe, Houston, TX 77025, United States
Author contributions: Mummadi RR collected the data, interpreted it, helped in preparation of the manuscript, and performed in fulfillment of requirements for MSc in Clinical Science; Petersen JR helped design the project, interpret the data, perform the statistics, and prepare the manuscript; Xiao SY read the liver biopsies and helped in the preparation of the manuscript; Snyder N helped design the project, collect the data, interpret the data, and prepare the manuscript.
Supported by Portions of this study were performed on the General Clinical Research Center at the University of Texas Medical Branch at Galveston, funded by M01 RR 00073 from the National Center for Research Resources, NIH, USPHS
Correspondence to: Dr. Ned Snyder, Department of Gastroenterology and Hepatology, Kelsey Seybold Clinic, 2727 W. Holcombe, Houston, TX 77025, United States. nesnyder@utmb.edu
Telephone: +1-713-4420520 Fax: +1-713-4420678
Received: July 20, 2010
Revised: September 3, 2010
Accepted: September 10, 2010
Published online: December 7, 2010
Abstract

AIM: To examine the accuracy of the aspartate aminotransferase (AST)/Platelet Ratio Index (APRI) and FIB-4, in predicting longitudinal changes in liver histology in hepatitis C virus (HCV) patients.

METHODS: Patients that underwent repeat liver biopsies at least 1 year apart from 1999 to 2007 were identified. Liver fibrosis was staged on needle core biopsies evaluated by a single expert liver pathologist. Only laboratory values within 3 mo of the liver biopsies were used.

RESULTS: Thirty-six patients met the inclusion criteria with 50% stage 1 on initial biopsy, 25% stage 2, and 22% stage 3. Nineteen of 36 (53%) had progression of fibrosis on repeat biopsies, while 16 (44%) showed no change in stage, and one (3%) showed improvement. Patients that showed progression of fibrosis had significantly higher alanine aminotransferase and aspartate aminotransferase levels than the group that did not show progression. A significant correlation was seen between change in stage of fibrosis and change in APRI (r² = 0.39, P = 0.00001) and a change in FIB-4 (r² = 0.31, P = 0.00004). A change in APRI (ΔAPRI) of 0.18 had 80% positive predictive value (PPV) and 67% negative predictive value (NPV) for progression of fibrosis. A change in FIB-4 (ΔFIB-4) of 0.39 had 75% PPV and 75% NPV for predicting progression of fibrosis.

CONCLUSION: ΔAPRI and ΔFIB-4 parallel changes in fibrosis progression, and could be useful tools for clinicians in following patients with active chronic HCV infection.

Keywords: Hepatitis C, Liver fibrosis, Liver biopsy, Biomarkers