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Non-invasive score system for fibrosis in chronic hepatitis: proposal for a model based on biochemical, FibroScan and ultrasound data
Silvia Gaia1,*, Daniela Campion1, Andrea Evangelista2, Maurizio Spandre1, Loretta Cosso1, Franco Brunello1, Giovannino Ciccone2, Elisabetta Bugianesi1 andMario Rizzetto1
Article first published online: 21 JAN 2015
DOI: 10.1111/liv.12761
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Issue
Liver International
Volume 35, Issue 8, pages 2027–2035, August 2015
1 Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy
2 Department of Epidemiology, Città della Salute e della Scienza - University Hospital, Turin, Italy
* Correspondence
Silvia Gaia, MD, Department of Gastroenterology, Città della Salute e della Scienza – University Hospital of Turin, c.so Bramante 88, 10100 Turin, Italy
Tel: +390116336485
Fax: +390116336752
e-mail: [email protected]
Handling Editor: Helena Cortez-Pinto
Publication History
Issue published online: 29 JUL 2015
Article first published online: 21 JAN 2015
Accepted manuscript online: 14 DEC 2014 11:29PM EST
Manuscript Accepted: 2 DEC 2014
Manuscript Received: 24 JUL 2014
Keywords:
chronic viral hepatitis;FibroScan;liver biopsy; NAFLD ;non-invasive fibrosis;ultrasound scan
Abstract
Background & Aims
We elaborate a non-invasive score system for liver fibrosis (NISF), exploring its diagnostic performance and comparing its accuracy to FibroScan in patients with chronic viral hepatitis (CH) and non-alcoholic fatty liver disease (NAFLD).
Methods
Clinical, biochemical, elastographic and ultrasound parameters derived from patients with CH (n = 83) or NAFLD (n = 58), undergoing liver biopsy for fibrosis assessment, were prospectively collected as potential predictors of fibrosis. Each parameter was evaluated for its correlation with the liver biopsy (Gold Standard). Candidate predictors with good interobserver agreement and correlation with histological stages were combined into two algorithms (NISF) to predict fibrosis in chronic viral hepatitis and NAFLD.
Results
The CH-NISF included six parameters: bluntness of liver edges, irregularity of left lobe surface, diameter of segment 4, liver stiffness measurement, platelet count and ALT values. The ability of the model to discriminate F3–F4 vs F0–F1 stages and F2 vs F0-F1 was high (AUROC of 0.95 and 0.83 respectively) and better than FibroScan alone, especially in intermediate stages (F2 vs F0-F1), AUROC 0.83 vs 0.57 (P = 0.003). The resulting algorithm is available as mathematical formula, nomogram or free online link. [http://health.mafservizi.it/NISF_Calculator/liver.htm]
The NAFLD-NISF included liver stiffness, platelet count and AST levels, had good ability to discriminate F0–F1 vs F2–F3–F4 stages (AUROC 0.86), however, not significantly higher than FibroScan.
Conclusions
CH-NISF can be proposed as preliminary and easily available staging tool, superior to FibroScan alone in predicting histological fibrosis, especially in intermediate stages. Further validations are needed to improve NISF accuracy in NAFLD.
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