ABSTRACT
Aim: Liver fibrosis in chronic hepatitis C is related to sex and age at infection. Several biochemical markers are highly predictive for the discrimination of significant fibrosis. The aims of this study were to compare an index of five-biochemical markers with histological features and to determine the utility of combining historical features [age and sex] with the five-marker index for the prediction of significant fibrosis. Subjects and Thirty untreated patients with chronic hepatitis C and a known duration of infection had a liver biopsy and serum tested for markers of fibrosis. The discriminative values of the markers and an index of historical features for the diagnosis of clinically significant fibrosis [F2-F4, by the Metavir scoring system] were compared using areas under receiving operating characteristic [ROC] curves. A modified index was constructed combining the five-marker index and historical features. Of the 30 patients included 70% were males. The median age at infection was 28 +/- 13 and the median duration of infection was 17 +/- 8 years. By multivariate logistic regression analysis, sex [P=0.003], age at biopsy [P-0.004] were independently predictive of F2-F4 fibrosis. For the discrimination of F2-F4 fibrosis, the areas under ROC curves were 0.796 +/- 0.033 for the five-marker index versus 0.709 +/- 0.037 for the historical index [P=0.079]. For diagnosis of advanced fibrosis [F3, F4] the areas under the curves were 0.920 +/- 0.032 and 0.762'0.049 [P=0.007], respectively. The discriminative value of the combined biochemical and historical index was not statistically significantly different from that of the five-marker index alone [P=ns]. Conclusions: A simple index including age, sex, and five biochemical markers accurately predicts significant hepatitis C related fibrosis