Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection
Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection
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DOI：
10.1002/hep.21178
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发表时间：
2006-06-01
期刊：
影响因子：
13.5
通讯作者：
Nelson, Mark
中科院分区：
文献类型：
--
作者：
Sterling, Richard K.;Lissen, Eduardo;Nelson, Mark
肝活检仍然是评估肝脏疾病严重程度的金标准。考虑到活检的相关风险，非侵入性测试已经流行来预测组织学。然而，许多模型包括不容易获得的测试，并且来自HIV/丙型肝炎病毒（HCV）合并感染患者的数据有限。我们的目的是建立一个模型，使用常规检测来预测HIV/HCV合并感染患者的肝纤维化。对832例患者的肝脏组织学进行了回顾性分析。通过Ishak评分评估肝纤维化;患者被分为0-1，2-3或4-6，并被随机分配到训练组（n = 555）或验证组（n = 277）。多因素Logistic回归分析显示，血小板计数（PLT）、年龄、AST和M与纤维化显著相关。其他分析显示PLT、年龄、AST和ALT可作为替代模型。基于此，开发了一个简单的指数（FIB-4）：年龄（[yr] x AST [U/L]）/（（PLT [10（9）/L]）X（ALT [U/L]）（1/2））。对于Ishak分期0-3和4-6之间的区分，该指数的AUROC为0.765。在验证集中，当截止值< 1.45时，排除晚期纤维化（4-6期）的阴性预测值为90%，灵敏度为70%。临界值> 3.25的阳性预测值为65%，特异性为97%。使用这些截止值，198例FIB-4值在1.45-3.25范围外的患者中有87%将被正确分类，验证组中有71%可以避免肝活检。总之，非侵入性检测可以准确预测肝纤维化，并可能减少大多数HIV/HCV合并感染患者对肝活检的需求。
Liver biopsy remains the gold standard in the assessment of severity of liver disease. Noninvasive tests have gained popularity to predict histology in view of die associated risks of biopsy. However, many models include tests not readily available, and there are limited data from patients with HIV/hepatitis C virus (HCV) coinfection. We aimed to develop a model using routine tests to predict liver fibrosis in patients with HIV/HCV coinfection. A retrospective analysis of liver histology was performed in 832 patients. Liver fibrosis was assessed via Ishak score; patients were categorized as 0-1, 2-3, or 4-6 and were randomly assigned to training (n = 555) or validation (n = 277) sets. Multivariate logistic regression analysis revealed that platelet count (PLT), age, AST, and M were significantly associated with fibrosis. Additional analysis revealed PLT, age, AST, and ALT as an alternative model. Based on this, a simple index (FIB-4) was developed: age ([yr] x AST [U/L])/((PLT [10(9)/L]) X (ALT [U/L])(1/2)). The AUROC of the index was 0.765 for differentiation between Ishak stage 0-3 and 4-6. At a cutoff of < 1.45 in the validation set, the negative predictive value to exclude advanced fibrosis (stage 4-6) was 90% with a sensitivity of 70%. A cutoff of > 3.25 had a positive predictive value of 65% and a specificity of 97%. Using these cutoffs, 87% of the 198 patients with FIB-4 values outside 1.45-3.25 would be correctly classified, and liver biopsy could be avoided in 71% of the validation group. In conclusion noninvasive tests can accurately predict hepatic fibrosis and may reduce the need for liver biopsy in the majority of HIV/HCV-coinfected patients.