Journal Article

A Novel Fibrosis Index Comprising a Non-Cholesterol Sterol Accurately Predicts HCV-Related Liver Cirrhosis

Langeland, Nina, Lisovskaja, Vera, Pedersen, Court, Buhl, Mads Rauning, Wejstål, Rune, Lindh, Magnus, Mørch, Kristine, Westin, Johan, Ydreborg, Magdalena, Färkkilä, Martti, Norkrans, Gunnar, Lagging, Martin, Brehm Christensen, Peer

2014

Overview

Diagnosis of liver cirrhosis is essential in the management of chronic hepatitis C virus (HCV) infection. Liver biopsy is invasive and thus entails a risk of complications as well as a potential risk of sampling error. Therefore, non-invasive diagnostic tools are preferential. The aim of the present study was to create a model for accurate prediction of liver cirrhosis based on patient characteristics and biomarkers of liver fibrosis, including a panel of non-cholesterol sterols reflecting cholesterol synthesis and absorption and secretion. We evaluated variables with potential predictive significance for liver fibrosis in 278 patients originally included in a multicenter phase III treatment trial for chronic HCV infection. A stepwise multivariate logistic model selection was performed with liver cirrhosis, defined as Ishak fibrosis stage 5-6, as the outcome variable. A new index, referred to as Nordic Liver Index (NoLI) in the paper, was based on the model: Log-odds (predicting cirrhosis) = -12.17+ (age × 0.11) + (BMI (kg/m(2)) × 0.23) + (D7-lathosterol (μg/100 mg cholesterol)×(-0.013)) + (Platelet count (x10(9)/L) × (-0.018)) + (Prothrombin-INR × 3.69). The area under the ROC curve (AUROC) for prediction of cirrhosis was 0.91 (95% CI 0.86-0.96). The index was validated in a separate cohort of 83 patients and the AUROC for this cohort was similar (0.90; 95% CI: 0.82-0.98). In conclusion, the new index may complement other methods in diagnosing cirrhosis in patients with chronic HCV infection.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: 1988 / 1990 / AMERICAN JOURNAL OF EPIDEMIOLOGY / Biomarkers / Biomarkers - blood / Biopsy / Body mass / Cholesterol / CHRONIC HEPATITIS-C / Chronic infection / CHRONIC VIRAL-HEPATITIS / Cirrhosis / Complications / Diagnostic software / Diagnostic systems / ETTINEN TA / Female / Fibrosis / Gallbladder diseases / Genotype & phenotype / Hepatitis / Hepatitis C / Hepatitis C - complications / Hepatitis C - pathology / Hepatology / HIV / Hospitals / Human immunodeficiency virus / Humans / Infections / Infectious diseases / Infectious Medicine / Infektionsmedicin / INSULIN-RESISTANCE / Interferon / JOURNAL OF LIPID RESEARCH / Liver / Liver cirrhosis / Liver Cirrhosis - complications / Liver Cirrhosis - pathology / Male / Mathematical models / Medicine and health sciences / Metabolism / Middle Aged / P20 / P43 / Patients / Predictions / PRIMARY BILIARY-CIRRHOSIS / Prothrombin / Sampling error / Secretion / SERUM MARKERS / STANDARD LABORATORY / STEATOSIS / Sterols / Sterols - metabolism / TESTS / TRANSIENT ELASTOGRAPHY / TRANSPLANTATION / V131 / V29 / Virology / VIRUS-INFECTION / Viruses