Cirrhosis Probability in Hepatitis C MultiCalc

Input

Age
Platelets
ALT		U/L
AST		U/L
Top Normal AST		U/L
INR

Results


CDS
Lok Index
GUCI
APRI
FIB4

Decimal Precision

CDS Interpretation

0 to 7 Points:	Cirrhosis less likely
8 to 11 Points:	Cirrhosis more likely

Lok Index Interpretation

Fraction < 0.2:	Cirrhosis less likely
Fraction >= 0.2 and <= 0.5:	Indeterminate
Fraction > 0.5:	Cirrhosis more likely

GUCI Interpretation

Point < 1:	Cirrhosis less likely
Point >= 1:	Cirrhosis more likely

APRI Interpretation

Points <= 0.5:	Significant Fibrosis or Cirrhosis less likely
Point > 0.5 and <= 1:	Significant Fibrosis indeterminate, Cirrhosis less likely
Points > 1 and <= 1.5:	Significant Fibrosis more likely, Cirrhosis indeterminate
Points > 1.5 and <= 2:	Significant Fibrosis more likely but Cirrhosis indeterminate
Points > 2:	Significant Fibrosis and Cirrhosis more likely

FIB-4 Interpretation

Points < 1.45:	Cirrhosis less likely
Points >= 1.45 and <= 3.25:	Indeterminate
Points > 3.25:	Cirrhosis more likely

Notes

Platelets is the platelet count. ALT is alanine aminotransferase. AST is aspartate aminotransferase and INR is the prothrombin time international normalized ratio.
Cirrhosis Discriminant Scores (CDS) >7 have a high predictive value of predicting cirrhosis with a specificity of >90%
In the Lok study, a Lok Index <0.2 missed only 7.8% of patients with cirrhosis while a Lok Index >0.5 misdiagnosed 14.8% of patients with cirrhosis.
In the Islam study, the Goteborg University Cirrhosis Index (GUCI) cutoff of 1.0 has a sensitivity of 80% and specificity of 78%.
Wai's AST to Platelet Ratio Index (APRI) cutoff values help predict both significant fibrosis and cirrhosis.
The FIB 4 index diagnostic cutoffs produce a negative predictive value of 94.7% with sensitivity 73.4%, and a positive predictive value of 82.1% with a specificity of 98.2%.

Equations used

CDS = PlateletScore + ALTASTRatioScore + INRScore

LogOddsLok = (1.26 * AST / ALT) + (5.27 * INR) - (0.0089 * Platelets) - 5.56

LokIndex = e^(LogOddsLok) / (1 + e^(LogOddsLok))

GUCI = (AST / TopNormalAST) * INR * 100 / Platelets

APRI = (AST / TopNormalAST) * (100 / Platelets)

FIB4 = Age * AST / (Platelets * sqr(ALT))

References

Udell JA, Wang CS, Tinmouth J, et al. Does this patient with liver disease have cirrhosis? JAMA. 2012 Feb 22;307(8):832-42. PubMed ID: 22357834
Bonacini M, Hadi G, Govindarajan S, Lindsay KL. Utility of a discriminant score for diagnosing advanced fibrosis or cirrhosis in patients with chronic hepatitis C virus infection. Am J Gastroenterol. 1997 Aug;92(8):1302-4. PubMed ID: 9260794
Lok AS, Ghany MG, Goodman ZD, et al. Predicting cirrhosis in patients with hepatitis C based on standard laboratory tests: results of the HALT-C cohort. Hepatology. 2005 Aug;42(2):282-92. PubMed ID: 15986415
Islam S, Antonsson L, Westin J, Lagging M. Cirrhosis in hepatitis C virus-infected patients can be excluded using an index of standard biochemical serum markers. Scand J Gastroenterol. 2005 Jul;40(7):867-72. PubMed ID: 16109665
Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003 Aug;38(2):518-26. PubMed ID: 12883497
Vallet-Pichard A, Mallet V, Nalpas B, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology. 2007 Jul;46(1):32-6. PubMed ID: 17567829

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