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

Journal article
Authors Magdalena Ydreborg
Vera Lisovskaja
Martin Lagging
P. B. Christensen
N. Langeland
M. R. Buhl
C. Pedersen
K. Morch
Rune Wejstål
Gunnar Norkrans
Magnus Lindh
M. Farkkila
Johan Westin
Published in Plos One
Volume 9
Issue 4
Pages artikel nr e93601
ISSN 1932-6203
Publication year 2014
Published at Department of Mathematical Sciences, Mathematical Statistics
Institute of Biomedicine, Department of Infectious Medicine
Pages artikel nr e93601
Language en
Links dx.doi.org/10.1371/journal.pone.009...
https://gup.ub.gu.se/file/189504
Keywords CHRONIC HEPATITIS-C, PRIMARY BILIARY-CIRRHOSIS, STANDARD LABORATORY, TESTS, CHRONIC VIRAL-HEPATITIS, TRANSIENT ELASTOGRAPHY, VIRUS-INFECTION, INSULIN-RESISTANCE, SERUM MARKERS, STEATOSIS, TRANSPLANTATION, ETTINEN TA, 1988, JOURNAL OF LIPID RESEARCH, V29, P43, ETTINEN TA, 1990, AMERICAN JOURNAL OF EPIDEMIOLOGY, V131, P20
Subject categories Infectious Medicine

Abstract

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+ (agex0.11) + (BMI (kg/m(2))x0.23) + (D-7-lathosterol (mu g/100 mg cholesterol)x(-0.013)) + (Platelet count (x10(9)/L)x(-0.018)) + (Prothrombin-INRx3.69). 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.

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