Evaluation of routine biochemical indices and alpha-fetoprotein versus histology in chronic hepatitis C patients

ABSTRACT

This study was conducted to investigate the value of routine biochemical indices and alpha -fetoprotein in the evaluation of liver fibrosis in chronic hepatitis C patients. One hundred and sixty two chronic hepatitis C patients were recruited for antiviral therapy in a national centre in Egypt. Patients were 127 males and 35 females with a mean age of 38.4 years. Patients were evaluated with laboratory tests needed to decide eligibility for antiviral therapy. Indices were calculated from aspartate to alanine aminotransferase ratio index [AARI], AST/platelet count for APRI, age/platelets index [API] and alpha -fetoprotein. Metavir score was used to stage fibrosis. Receiver Operator Characteristic curves was used. Prevalence of significant fibrosis [F2-4] was 86 patients [53%]; 10 patients [6.1%] were cirrhotics. In patients with significant fibrosis AARI had sensitivity rate [80%], specificity [30%] and AUC value [0.594]. APRI, API and AFP had a better specificity than AARI [54%, 76% and 55%, respectively], with a lower sensitivity [68%, 61% and 62%] and AUC [0.644, 0.699 and 0.613, respectively]. Combining non-invasive indices with alpha-fetoprotein, the specificity did not improve, though sensitivity increased. age/platelets count index [API] had highest sensitivity [100%] with specificity [59%] and AUC = 0.832 for prediction of liver cirrhosis, whereas APRI showed higher specificity [65%] but lower sensitivity rates [70%] and AUC = 0.644. API is useful in discriminating patients with significant fibrosis, showing the best in this study in predicting cirrhosis. Adding AFP to AARI, APRI or API showed no value in increasing prediction of significant fibrosis