Novel scores combining AFP with non-invasive markers for prediction of liver fibrosis in chronic hepatitis C patients

2018 Journal of Medical Virology In Press;

BACKGROUND: Serum levels of alpha-fetoprotein (AFP) were reported to increase in patients with significant or advanced hepatic fibrosis. Combination of non-invasive tests decreases the use of liver biopsy in large proportion of chronic HCV patients. AIM: To compare and combine AFP with commonly used non-invasive fibrosis tests in novel scores for prediction of different stages of hepatic fibrosis. PATIENTS AND METHODS: Six hundred and fifty two treatment naive chronic hepatitis C patients were enrolled. Demographic data, basic pre-treatment laboratory tests (complete blood count (CBC), liver biochemical profile and renal functions test, international normalized ratio (INR) in addition to AFP, liver stiffness measurement (LSM) by Fibroscan and liver biopsies were retrospectively analyzed. AST to Platelet Ratio Index (APRI) and FIB-4 scores were calculated. Different predictive models using multivariate logistic regression analysis were generated and presented in equations (scores) composed of a combination of AFP, LSM plus FIB-4/APRI scores. RESULTS: AFP was correlating significantly with LSM, FIB-4 and APRI scores. Areas under receiver operating characteristic curves (AUROCs) for predicting significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis were 0.897, 0.931 and 0.955 respectively for equations (scores) containing AFP, LSM and FIB-4. AUROCs for predicting significant hepatic fibrosis, advanced hepatic fibrosis and cirrhosis were 0.897, 0.929 and 0.959 respectively for equations (scores) containing AFP, LSM and APRI. CONCLUSION: Combining AFP to serum biomarkers and LSM increases their diagnostic performance for prediction of different stages of liver fibrosis. This article is protected by copyright. All rights reserved.

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