Prothrombin index is an indirect marker of severe liver fibrosis

liver411

European Journal of Gastroenterology & Hepatology 2002; 14(10):1133-1141

Prothrombin index is an indirect marker of severe liver fibrosis

Vincent Croquet a; Eric Vuillemin a; Catherine Ternisien b; Christophe
Pilette a; Frédéric Oberti a; Yves Gallois c; Marc Trossaert b; Marie
Christine Rousselet d; Daniel Chappard e; Paul Calès a

Objective
The non-invasive diagnosis of liver fibrosis is based mainly on biochemical
markers. The main aim was to validate whether the prothrombin index is an indirect marker of the severity of liver fibrosis.

Patients and methods
The predictive value of the prothrombin index for liver fibrosis was first
assessed in 243 patients with chronic liver disease, then validated in 193
other patients with chronic liver disease. The reproducibility of
measurement of the prothrombin index in different laboratories was evaluated in 82 other patients.

Results
In the first group, the prothrombin index was predicted accurately by serum hyaluronate (R2 = 0.67 at the first step by multiple regression). The
relationship between the prothrombin index and the area of fibrosis was not influenced significantly by non-fibrotic pathological lesions. The
prothrombin index began to decrease when the Metavir fibrosis score was 2 versus 3 for albumin. In the second group, the prothrombin index and the histological fibrosis score were well correlated (r = -0.70, P < 10-4).
Prothrombin index ?80% or ?70% diagnosed severe fibrosis or cirrhosis,
respectively, and prothrombin index ?105% or ?100% excluded a diagnosis of severe fibrosis or cirrhosis, respectively, at the 95% probability level.
The prothrombin indices measured in different laboratories were similar (78
± 18% v. 78 ± 14%) and well correlated (r = 0.91, P < 10-4).

Conclusions
The prothrombin index was well correlated with pathological liver fibrosis
score, had a high diagnostic accuracy for severe fibrosis or cirrhosis
especially due to alcohol, and was not influenced by other pathological
lesions. The prothrombin index was reproducible. Thus, the prothrombin index expressed as a percentage is an accurate, reproducible, inexpensive and easily available marker of severe liver fibrosis.

aService d'Hépato-Gastroentérologie, bLaboratoire d'Hématologie,
cLaboratoire de Biochimie, dLaboratoire d'Anatomopathologie and eLaboratoire d'Histologie, Embryologie et Cytologie, CHU, Angers, France

Correspondence to Paul Calès MD, Service d'Hépato-Gastroentérologie, CHU, 49033 Angers, Cedex 01, France Tel: +33 2 41 35 34 10; fax: +33 2 41 35 41 19; e-mail: [email protected]
Received 27 June 2001
Revised 14 November 2001
Accepted 16 January 2002