TY - JOUR
T1 - Serum fibrosis markers for the diagnosis of liver disease among peoplewith chronic hepatitis C in Chennai, India
AU - Cepeda, Javier A.
AU - Solomon, Sunil S.
AU - Srikrishnan, Aylur K.
AU - Nandagopal, Paneerselvam
AU - Balakrishnan, Pachamuthu
AU - Kumar, Muniratnam S.
AU - Thomas, David L.
AU - Sulkowski, Mark S.
AU - Mehta, Shruti H.
N1 - Funding Information:
We thank the study staffand the participants in the study. This work was funded by the National Institute on Drug Abuse (grant numbers R01DA026727 [to S. H. M.], DP2DA040244 [to S. S. S.], and R37DA013806 [to D. L. T.]); and the National Institute of Allergy and Infectious Diseases (grant number P30AI094189 [to the Johns Hopkins Center for AIDS Research] and institutional training grant T32AI102623).
Publisher Copyright:
© The Author 2016.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Background. Access to hepatitis C virus (HCV) treatment is limited in low- and middle-income countries (LMICs). Noninvasive biomarkers, such as fibrosis 4 (FIB-4) and aminotransferase to platelet ratio index (APRI), are low-cost alternatives to staging liver disease and identifying treatment need in people with chronic HCV infection, but their accuracy has not been evaluated in LMICs. Methods. We tested the accuracy of FIB-4 and APRI at validated cutoffs (FIB-4 < 1.45, > 3.25; APRI < 0.5, > 1.5) in predicting severe liver stiffness by elastography among 281 persons chronically infected with HCV. Multivariable logistic and Cox regression were used to identify markers of improved prediction and mortality, respectively. Results. Sensitivity and specificity of FIB-4 and APRI for predicting severe stiffness were 62% and 87% and 61% and 83%, respectively. Fibrosis 4 and APRI were less accurate in excluding significant stiffness; however, performance of models significantly improved with γ-glutamyl transpeptidase (GGT) and body mass index (BMI) (area under receiver operating characteristic curve, 0.81; 95% confidence interval,.76-.87). Severe liver stiffness predicted via FIB-4 > 3.25, APRI > 1.5, and a modified FIB-4 that included GGT and BMI were significantly associated with increased mortality. Conclusions. Fibrosis 4 and APRI may be useful in identifying individuals with severe stiffness who need treatment and continued monitoring in LMICs. Exclusion of significant stiffness may be improved by including GGT and BMI to FIB-4 models.
AB - Background. Access to hepatitis C virus (HCV) treatment is limited in low- and middle-income countries (LMICs). Noninvasive biomarkers, such as fibrosis 4 (FIB-4) and aminotransferase to platelet ratio index (APRI), are low-cost alternatives to staging liver disease and identifying treatment need in people with chronic HCV infection, but their accuracy has not been evaluated in LMICs. Methods. We tested the accuracy of FIB-4 and APRI at validated cutoffs (FIB-4 < 1.45, > 3.25; APRI < 0.5, > 1.5) in predicting severe liver stiffness by elastography among 281 persons chronically infected with HCV. Multivariable logistic and Cox regression were used to identify markers of improved prediction and mortality, respectively. Results. Sensitivity and specificity of FIB-4 and APRI for predicting severe stiffness were 62% and 87% and 61% and 83%, respectively. Fibrosis 4 and APRI were less accurate in excluding significant stiffness; however, performance of models significantly improved with γ-glutamyl transpeptidase (GGT) and body mass index (BMI) (area under receiver operating characteristic curve, 0.81; 95% confidence interval,.76-.87). Severe liver stiffness predicted via FIB-4 > 3.25, APRI > 1.5, and a modified FIB-4 that included GGT and BMI were significantly associated with increased mortality. Conclusions. Fibrosis 4 and APRI may be useful in identifying individuals with severe stiffness who need treatment and continued monitoring in LMICs. Exclusion of significant stiffness may be improved by including GGT and BMI to FIB-4 models.
KW - FIB-4
KW - Hepatitis C virus
KW - India
KW - Liver stiffness
KW - People who inject drugs
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U2 - 10.1093/ofid/ofw156
DO - 10.1093/ofid/ofw156
M3 - Article
AN - SCOPUS:85015895167
SN - 2328-8957
VL - 3
JO - Open Forum Infectious Diseases
JF - Open Forum Infectious Diseases
IS - 3
ER -