Multiple approaches to assess fourteen non-invasive serum indexes for the diagnosis of liver fibrosis in chronic hepatitis C patients

• CDS, HGM-2, MODEL3, FI and FCI should be included in an algorithm for diagnosing F = 4.
• The same indexes should be included in an algorithm for identifying advanced fibrosis.
• For diagnosing F ≥ 2, FIB4, GUCI, APRI and HGM-2 are the best indexes.
• A combination of indexes could be used for the diagnosis and follow-up of liver fibrosis stages.
• HGM-2 and FIB4 show very good results for mono-infected CHC patients.

BackgroundThe aim of this study was to compare fourteen non-invasive indexes/scores: AAR, APRI, Fibroindex, MODEL3, Forns index, FIB4, GUCI, FI, FCI, Pohl score, AP index, CDS, HGM-1 and HGM-2, in order to diagnose the hepatic fibrosis stage in a survey of patients with chronic hepatitis C.Methods84 patients with chronic hepatitis C were studied. Liver fibrosis was staged according to the Scheuer scoring system. The diagnostic accuracy of these indexes/scores was evaluated by AUROC, contingency tables and logistic regression analysis.ResultsThe best AUROCs (> 0.9) to discriminate cirrhosis (F = 4), were observed for CDS, FI, AAR, MODEL3, FIB4, HGM-2 and FCI. To discriminate at least advance fibrosis (F ≥ 3), the best AUROCs (> 0.89) were for CDS, FI, FIB4, HGM2-2, MODEL3 and FCI. To discriminate at least significant fibrosis (F ≥ 2), the best AUROCs (> 0.8) were for FIB4, GUCI, APRI, FI, Forns index, HGM-2 and FCI. Contingency tables and logistic regression analysis supported the results obtained by AUROC.ConclusionsThis study compares the diagnostic performance of fourteen indexes for the diagnosis of liver fibrosis stage in the same group of CHC patients. These results allow the selection of the best indexes for further studies in larger populations, in order to build diagnostic algorithms as an alternative to liver biopsy for fibrosis staging in patients with chronic HCV infection. These algorithms would allow to take therapeutical decisions and the continuous follow-up of hepatic fibrosis in these patients.

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