Historical features are poor predictors of liver fibrosis in Canadian patients with chronic hepatitis C

The progression of fibrosis in chronic hepatitis C infection (HCV) is relat ed to host factors including age, gender and alcohol consumption. Due to th e morbidity and potential mortality of liver biopsy, a noninvasive method o f assessing hepatic fibrosis is needed. The aim of this study was to assess the utility of historical features in predicting fibrosis using published rates of fibrosis progression. The charts of 239 untreated patients with HC V were reviewed; patients who had a liver biopsy and whose duration of infe ction could be estimated (n=106) were categorized according to gender, age at infection (less than or equal to or > 40 years) and peak alcohol consump tion (< or greater than or equal to 50 g/day). Estimates of fibrosis were c alculated using the product of the interval between infection and biopsy an d published rates of fibrosis progression. Estimates were compared with liv er biopsies staged according to the Metavir system (F0-F4; F0=no fibrosis; F4= cirrhosis). The mean age of patients was 42 +/- 8 years, 61% were male and 36% consumed > 50 g of alcohol daily. The mean duration of infection wa s 19 +/- 9 years (range, 1-40) and ALT was elevated > 1.5 times upper norma l in 63%. When patients were classified into those with mild (F0-F2) and se vere (F3-F4) fibrosis, the sensitivity, specificity, positive predictive va lue and negative predictive value of an estimate of mild fibrosis was 60%, 55%, 78% and 34%, respectively. An estimate of severe fibrosis had a sensit ivity of 55%, specificity of 60%, positive predictive value of 34% and nega tive predictive value of 78%. Agreement between fibrosis estimates and actu al histological stages was poor (kappa = 0.13, P=0.08). The prediction of h epatic fibrosis in HCV infection using historical features and published ra tes of fibrosis progression is poor in a Canadian clinical practice setting . Alternate noninvasive methods of predicting hepatic fibrosis are needed.