A non-invasive algorithm accurately predicts advanced fibrosis in hepatitis C: A comparison using histology with internal-external validation

Silvia Paggi, Agostino Colli, Mirella Fraquelli, Mauro Viganò, Paolo Del Poggio, Corinna Facciotto, Massimo Colombo, Guido Ronchi, Dario Conte

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background/Aims: Biochemical tests and ultrasonography (US) are useful in the non-invasive assessment of liver fibrosis in patients with chronic hepatitis C (CH-C); however histology remains the reference standard. This multicenter, cross-sectional cohort study evaluated the accuracy of APRI (AST-to-platelet-ratio-index) and liver surface ultrasound nodularity (LSN), singularly and sequentially combined in an algorithm, in diagnosing advanced fibrosis (i.e. METAVIR F3, F4), to derive a prediction rule to confirm or exclude F3, F4. Methods: Four hundred and thirty consecutive CH-C patients with elevated ALT, grouped into a first cohort (training set), and an internal and an external validation cohort, were studied. APRI and LSN were compared to liver biopsy and sequentially combined in order to obtain a predictive rule for advanced fibrosis METAVIR F3, F4. Results: LSN was negative and APRI ≤ 1 in 185/430 patients, whereas LSN was positive and APRI > 2 in 46/430 cases, with a 94% diagnostic accuracy for presence/absence of F3, F4, respectively. In a further 60/430 patients, F3, F4 was detected with an accuracy of 83%. In the remaining cases no classification was possible. Conclusions: An algorithm based on APRI and LSN confirms or excludes F3, F4 in 54% of CH-C patients with elevated ALT and suggests a highly probable diagnosis in a further one-sixth of patients, thus rendering liver biopsy unnecessary in these patients.

Original languageEnglish
Pages (from-to)564-571
Number of pages8
JournalJournal of Hepatology
Volume49
Issue number4
DOIs
Publication statusPublished - Oct 2008

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Hepatitis C
Histology
Fibrosis
Liver
Blood Platelets
Chronic Hepatitis C
Biopsy
Liver Cirrhosis
Ultrasonography
Cohort Studies
Cross-Sectional Studies

Keywords

  • APRI score
  • Chronic hepatitis C
  • Liver fibrosis
  • Predictive algorithm
  • Ultrasonography

ASJC Scopus subject areas

  • Gastroenterology

Cite this

A non-invasive algorithm accurately predicts advanced fibrosis in hepatitis C : A comparison using histology with internal-external validation. / Paggi, Silvia; Colli, Agostino; Fraquelli, Mirella; Viganò, Mauro; Poggio, Paolo Del; Facciotto, Corinna; Colombo, Massimo; Ronchi, Guido; Conte, Dario.

In: Journal of Hepatology, Vol. 49, No. 4, 10.2008, p. 564-571.

Research output: Contribution to journalArticle

Paggi, Silvia ; Colli, Agostino ; Fraquelli, Mirella ; Viganò, Mauro ; Poggio, Paolo Del ; Facciotto, Corinna ; Colombo, Massimo ; Ronchi, Guido ; Conte, Dario. / A non-invasive algorithm accurately predicts advanced fibrosis in hepatitis C : A comparison using histology with internal-external validation. In: Journal of Hepatology. 2008 ; Vol. 49, No. 4. pp. 564-571.
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abstract = "Background/Aims: Biochemical tests and ultrasonography (US) are useful in the non-invasive assessment of liver fibrosis in patients with chronic hepatitis C (CH-C); however histology remains the reference standard. This multicenter, cross-sectional cohort study evaluated the accuracy of APRI (AST-to-platelet-ratio-index) and liver surface ultrasound nodularity (LSN), singularly and sequentially combined in an algorithm, in diagnosing advanced fibrosis (i.e. METAVIR F3, F4), to derive a prediction rule to confirm or exclude F3, F4. Methods: Four hundred and thirty consecutive CH-C patients with elevated ALT, grouped into a first cohort (training set), and an internal and an external validation cohort, were studied. APRI and LSN were compared to liver biopsy and sequentially combined in order to obtain a predictive rule for advanced fibrosis METAVIR F3, F4. Results: LSN was negative and APRI ≤ 1 in 185/430 patients, whereas LSN was positive and APRI > 2 in 46/430 cases, with a 94{\%} diagnostic accuracy for presence/absence of F3, F4, respectively. In a further 60/430 patients, F3, F4 was detected with an accuracy of 83{\%}. In the remaining cases no classification was possible. Conclusions: An algorithm based on APRI and LSN confirms or excludes F3, F4 in 54{\%} of CH-C patients with elevated ALT and suggests a highly probable diagnosis in a further one-sixth of patients, thus rendering liver biopsy unnecessary in these patients.",
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AU - Paggi, Silvia

AU - Colli, Agostino

AU - Fraquelli, Mirella

AU - Viganò, Mauro

AU - Poggio, Paolo Del

AU - Facciotto, Corinna

AU - Colombo, Massimo

AU - Ronchi, Guido

AU - Conte, Dario

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N2 - Background/Aims: Biochemical tests and ultrasonography (US) are useful in the non-invasive assessment of liver fibrosis in patients with chronic hepatitis C (CH-C); however histology remains the reference standard. This multicenter, cross-sectional cohort study evaluated the accuracy of APRI (AST-to-platelet-ratio-index) and liver surface ultrasound nodularity (LSN), singularly and sequentially combined in an algorithm, in diagnosing advanced fibrosis (i.e. METAVIR F3, F4), to derive a prediction rule to confirm or exclude F3, F4. Methods: Four hundred and thirty consecutive CH-C patients with elevated ALT, grouped into a first cohort (training set), and an internal and an external validation cohort, were studied. APRI and LSN were compared to liver biopsy and sequentially combined in order to obtain a predictive rule for advanced fibrosis METAVIR F3, F4. Results: LSN was negative and APRI ≤ 1 in 185/430 patients, whereas LSN was positive and APRI > 2 in 46/430 cases, with a 94% diagnostic accuracy for presence/absence of F3, F4, respectively. In a further 60/430 patients, F3, F4 was detected with an accuracy of 83%. In the remaining cases no classification was possible. Conclusions: An algorithm based on APRI and LSN confirms or excludes F3, F4 in 54% of CH-C patients with elevated ALT and suggests a highly probable diagnosis in a further one-sixth of patients, thus rendering liver biopsy unnecessary in these patients.

AB - Background/Aims: Biochemical tests and ultrasonography (US) are useful in the non-invasive assessment of liver fibrosis in patients with chronic hepatitis C (CH-C); however histology remains the reference standard. This multicenter, cross-sectional cohort study evaluated the accuracy of APRI (AST-to-platelet-ratio-index) and liver surface ultrasound nodularity (LSN), singularly and sequentially combined in an algorithm, in diagnosing advanced fibrosis (i.e. METAVIR F3, F4), to derive a prediction rule to confirm or exclude F3, F4. Methods: Four hundred and thirty consecutive CH-C patients with elevated ALT, grouped into a first cohort (training set), and an internal and an external validation cohort, were studied. APRI and LSN were compared to liver biopsy and sequentially combined in order to obtain a predictive rule for advanced fibrosis METAVIR F3, F4. Results: LSN was negative and APRI ≤ 1 in 185/430 patients, whereas LSN was positive and APRI > 2 in 46/430 cases, with a 94% diagnostic accuracy for presence/absence of F3, F4, respectively. In a further 60/430 patients, F3, F4 was detected with an accuracy of 83%. In the remaining cases no classification was possible. Conclusions: An algorithm based on APRI and LSN confirms or excludes F3, F4 in 54% of CH-C patients with elevated ALT and suggests a highly probable diagnosis in a further one-sixth of patients, thus rendering liver biopsy unnecessary in these patients.

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