Value of PAPAS index as a marker in diagnosis of liver fibrosis in patients with chronic hepatitis C in comparison to FIB-4&FibroQ

Abstract

Summary T he 2010 Global Burden of Disease study -the first to include underlying causes of deaths due to cirrhosis and liver cancer- has identified chronic viral hepatitis as one of the leading causes of mortality worldwide. According to the 64th AASLD Liver Meeting, About 45% of liver cancer and 30% of cirrhosis is related to chronic hepatitis B, which is endemic in much of Asia and Africa, while chronic hepatitis C and alcohol use are each responsible for about 25% of deaths (Cowie and Maclachlan, 2013). Diagnosis of the stage of liver fibrosis is essential for making a prognosis regarding the development of cirrhosis and hepatocellular carcinoma; and deciding an antiviral therapy and follow-up both during treatment and after cessation of treatment(Cadranel et al., 2000). The diagnostic value of serum markers of liver fibrosis has been investigated in numerous studies. The ideal marker for liver fibrosis would be highly sensitive and specific to identify different stages of fibrosis and readily available, safe, inexpensive and reproducible to allow the monitoring of disease progression or regression as a part of natural history of liver disease or treatment regimens (Baranova et al., 2011). Therefore the primary aim of this study was to evaluate the role of PAPAS index as one of the non-invasive markers in diagnosis of liver fibrosis in patients with chronic hepatitis C compared to FibroQ and FIB-4. The study was conducted on 40 patients with chronic hepatitis C diagnosed by HCV Ab+ve by ELISA + quantitative PCR, attended Internal Medicine clinic in Nasr city Health Insurance Hospital prior to combination therapy. All patients were subjected to full medical history, physical examination, laboratory investigation(CBC, PT INR, Albumin, AST, ALT, ALP, T.BIL, D.BIL, Urea, Creatinine, HBsAg, HCV Ab, Bil Ab, HCV PCR, ANA, ASMA, AFP, Ceruloplasmmin, Fasting &2H PP Bl sugar), abdominal ultrasonography and transient elastography(fibroscan). Routine labs were applied for PAPAS, FIB-4 and FibroQ as simple methods for detection of hepatic fibrosis. In our study we found that were significant positive correlations between PAPAS index, FIB-4 and FibroQ with the degree of hepatic fibrosis measured by transient elastography. FIB-4 had the highest correlation with degree of fibrosis. In our study we found that that PAPAS index, FIB-4 and FibroQ were significantly higher in patients with advanced fibrosis(F3-F4) than patients with non-advanced fibrosis(F1-F2), only PAPAS index was higher in F3 than F2. Using cutoff value ≥2.05 for PAPAS index in detecting advanced fibrosis (F3-F4) PAPAS index had highly significant diagnostic performance and characteristics with sensitivity 100%, specificity 95.2%, PPV 95% and NPV 100%. In our study we found that FibroQ index had significant fair diagnostic performance at cutoff value ≥ 2.3 in detecting advanced fibrosis withgood sensitivity 94.7%, NPV 92.3% and LR-, but low specificity 57.1% and low PPV 66.7%. In our study we found that FIB-4 index had significant fair diagnostic performance at cutoff value ≥ 1.2 in detecting advanced fibrosis (F≥3) with good sensitivity 100%, NPV 100% and LR-, but low specificity 61.9% and low PPV 70.4%. In our study we found that there were highly significant positive correlations between PAPAS, FIB-4 and FibroQ with age and no correlation between age and degree of fibrosis measured by transient elastography.