Brief Article
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World J Gastroenterol. Jun 21, 2012; 18(23): 2988-2994
Published online Jun 21, 2012. doi: 10.3748/wjg.v18.i23.2988
Noninvasive assessment of hepatic fibrosis in Egyptian patients with chronic hepatitis C virus infection
Shawky Abdelhamid Fouad, Serag Esmat, Dalia Omran, Laila Rashid, Mohamed H Kobaisi
Shawky Abdelhamid Fouad, Serag Esmat, Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Dalia Omran, Department of Tropical Medicine, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Laila Rashid, Department of Biochemistry, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Mohamed H Kobaisi, Department of Pathology, National Institute of Nephrology, Cairo 35789, Egypt
Author contributions: Fouad SA, Esmat S and Omran D designed the study and collected the clinical data; Rashid L performed the laboratory analysis; Kobaisi MH performed the histopathological analysis; Fouad SA wrote the manuscript; Esmat S critically revised the manuscript for important intellectual content; all authors contributed to the selection of patients, drafting of the article and analysis of the results, and approved the version to be published.
Correspondence to: Serag Esmat, MD, Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo 11562, Egypt. seragesmat@yahoo.com
Telephone: +20-2-3646394 Fax: +20-2-3657104
Received: August 20, 2011
Revised: October 15, 2011
Accepted: October 21, 2011
Published online: June 21, 2012
Abstract

AIM: To evaluate the accuracy of specific biochemical markers for the assessment of hepatic fibrosis in patients with chronic hepatitis C virus (HCV) infection.

METHODS: One hundred and fifty-four patients with chronic HCV infection were included in this study; 124 patients were non-cirrhotic, and 30 were cirrhotic. The following measurements were obtained in all patients: serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, total bilirubin, prothrombin time and concentration, complete blood count, hepatitis B surface antigen (HBsAg), HCVAb, HCV-RNA by quantitative polymerase chain reaction, abdominal ultrasound and ultrasonic-guided liver biopsy. The following ratios, scores and indices were calculated and compared with the results of the histopathological examination: AST/ALT ratio (AAR), age platelet index (API), AST to platelet ratio index (APRI), cirrhosis discriminating score (CDS), Pohl score, Göteborg University Cirrhosis Index (GUCI).

RESULTS: AAR, APRI, API and GUCI demonstrated good diagnostic accuracy of liver cirrhosis (80.5%, 79.2%, 76.6% and 80.5%, respectively); P values were: < 0.01, < 0.05, < 0.001 and < 0.001, respectively. Among the studied parameters, AAR and GUCI gave the highest diagnostic accuracy (80.5%) with cutoff values of 1.2 and 1.5, respectively. APRI, API and GUCI were significantly correlated with the stage of fibrosis (P < 0.001) and the grade of activity (P < 0.001, < 0.001 and < 0.005, respectively), while CDS only correlated significantly with the stage of fibrosis (P < 0.001) and not with the degree of activity (P > 0.05). In addition, we found significant correlations for the AAR, APRI, API, GUCI and Pohl score between the non-cirrhotic (F0, F1, F2, F3) and cirrhotic (F4) groups (P values: < 0.001, < 0.05, < 0.001, < 0.001 and < 0.005, respectively; CDS did not demonstrate significant correlation (P > 0.05).

CONCLUSION: The use of AAR, APRI, API, GUCI and Pohl score measurements may decrease the need for liver biopsies in diagnosing cirrhosis, especially in Egypt, where resources are limited.

Keywords: Age platelet index; Aspartate aminotransferase platelet ratio index; Aspartate aminotransferase-to-alanine aminotransferase ratio; Cirrhosis discriminating score; Fibrosis evaluation; Göteborg University Cirrhosis Index; Hepatitis C virus infection; Liver fibrosis; Pohl score