HEPATITIS C virus (HCV) infection remains a significant cause of chronic liver disease globally. However, Egypt, previously noted for its high HCV prevalence, has made remarkable progress in reducing infection rates through strategic national interventions. Despite this achievement, liver fibrosis, a major consequence of chronic HCV, continues to challenge researchers seeking innovative diagnostic and treatment approaches.
Traditionally, liver biopsy was considered the gold standard for assessing fibrosis. Yet, due to its invasiveness, associated risks, and advancements in HCV therapies, both patients and clinicians increasingly seek noninvasive alternatives. These methods, including serum biomarkers and imaging modalities, allow for reliable and accessible fibrosis evaluation without the complications of biopsy.
Among serum biomarkers, the FIB-4 and APRI scores are widely recognised for assessing advanced fibrosis and cirrhosis. FIB-4 is particularly effective, with studies showing that a cutoff below 1.45 reliably excludes significant fibrosis, while values above 3.25 confirm advanced fibrosis with high sensitivity and specificity. Notably, a recent Egyptian cohort study identified a new FIB-4 cutoff of 2.01 for advanced fibrosis and 2.21 for cirrhosis, achieving better accuracy in local populations.
Similarly, APRI remains a valuable tool, though its accuracy varies with thresholds. In the Egyptian study, cutoffs for APRI ranged from 0.55 for significant fibrosis to 0.88 for cirrhosis, reflecting lower diagnostic performance compared to FIB-4. King’s score also demonstrated strong predictive capability for fibrosis stages, with an area under the curve (AUC) of 0.82 for cirrhosis at a threshold of 17.4.
Other tools, such as Fibro-Q and Fibro Index, showed promise but require further validation. Meanwhile, Fibro-α score proved less effective in the cohort, highlighting the variability of noninvasive methods based on population characteristics and disease parameters.
This study highlights the reliability of FIB-4 and King’s score as superior tools for prioritising patient surveillance and monitoring in HCV management. Combining scores may enhance diagnostic accuracy, particularly in resource-limited settings, ensuring better care and early intervention for at-risk individuals.
Reference
El-Kassas M et al. Comparison of different noninvasive scores for assessing hepatic fibrosis in a cohort of chronic hepatitis C patients. Sci Rep. 2024;14(1):29544.
