VAP score as a novel non-invasive liver fibrosis model in patients with chronic hepatitis C.

Hassan HE, Abd El-Rehim SE, Sayed ZE et al.

Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Assiut, Egypt.

Hepatology research : the official journal of the Japan Society of Hepatology. Feb 2017.

Assessment of liver fibrosis in chronic hepatitis C (CHC) patients is necessary before antiviral treatment. This study aimed to evaluate the effectiveness of eight noninvasive models (AAR, APRI, FCI, FI, FIB-4, FibroQ, King and VITRO scores) for predicting fibrosis compared with liver biopsy and to create a new score for predicting different fibrosis stages with increased accuracy.We prospectively studied 127 treatment-naive CHC patients who underwent liver biopsy. AAR, APRI, FCI, FI, FIB-4, FibroQ, King and VITRO scores were calculated and correlated with fibrosis stages. A new score (VAP) was derived from von-Willebrand factor-Ag (vWF-Ag), AST and platelets [VAP = (AST (U/L) X vWF-Ag)/Platelets (10(9) /L)].Apart from AAR, readily available scores were correlated with liver fibrosis stages. VITRO (r = 0.62) and APRI (r = 0.46) showed the closest correlation. Our new (VAP) score significantly correlated with fibrosis stages (r = 0.702, P < 0.001). Compared to other scores, VAP had the highest AUCs (0.854, 0.921, 0.849 and 0.861 for mild (F1), significant (≥F2), advanced (≥F3) fibrosis and cirrhosis (F4) respectively). At a cut-off value >1, VAP had 75.2% sensitivity and 100%PPV for predicting mild fibrosis and at the cut-off >2.3 for predicting cirrhosis were 73% sensitivity and 81.7%PPV.VAP score is a novel model that had higher diagnostic performance to predict different fibrosis stages and subclinical cirrhosis among CHC patients compared to the other studied scores and hence may offer a useful strategy to stratify patients who would benefit from direct-acting anti-virals.


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