Noninvasive Hepatic Fibrosis Algorithms Effectively Assess HCV Cirrhosis

Liver cirrhosis
Liver cirrhosis
The reliability of noninvasive diagnostic algorithms to exclude cirrhosis in patients infected with HCV was examined.

Noninvasive hepatic fibrosis scoring algorithms based on demographic data and laboratory measurements may help reduce reliance on transient elastography (TE) by quickly and accurately determining the presence of cirrhosis in patients with the hepatitis C virus (HCV), according to findings from a retrospective and prospective study published in PLoS One.

A total of 850 consecutive patients referred to a tertiary care center or sexual health clinic, as well as those who were receiving care in a prison-based hepatitis program, were included for data analysis. Published and newly derived cut-off values were used to quantify the negative predictive value (NPV) of 7 noninvasive algorithms, including the aminotransferase-to-platelet ratio index (APRI), cirrhosis discriminant score (CDS), Fibrosis-4 (FIB-4) score, Forns’ Index, Goteborg University Cirrhosis Index (GUCI), King’s Score, and Lok Index. The investigators assessed the number of avoided TEs per algorithm.

In this cohort, patients were categorized as being mono-infected with HCV (n=780) or being co-infected with HCV and HIV or hepatitis B (n=70). The cohort of patients with HCV monoinfection presented with an overall cirrhosis prevalence of 16%. A NPV of 94% (95% CI, 91%-96%) was observed for an APRI cut-off value of 1.0.

A 99% NPV (95% CI, 97%-100%) was observed for newly derived cut-off values in the APRI (0.49), FIB-4 (0.93), and GUCI (0.5) algorithms, which facilitated TE avoidance in 40% of patients in each algorithm. When the APRI (<0.49), FIB-4 (<0.93), and GUCI (<0.5) were used in combination, the NPVs were sustained and TE avoidance was 54%.

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The retrospective nature, as well as the limited number of sites, included in the analysis represents the primary limitations of this study. Also, the majority of the cohort was composed of men (79%), which may reduce the generalizability of the findings.

Using these algorithms in clinical practice for “streamlining and simplifying the assessment process in a significant proportion of patients will assist in improving the care cascade” by helping clinicians eliminate the possibility of cirrhosis and “move on to more readily prescribe, treat and cure chronic HCV.”


Kelly ML, Riordan SM, Bopage R, Lloyd AR, Post JJ. Capacity of non-invasive hepatic fibrosis algorithms to replace transient elastography to exclude cirrhosis in people with hepatitis C virus infection: A multi-centre observational study. PLoS One. 2018;13(2):e0192763.