Fibrosis Index and FIB4 in Prediction of HCC in Chronic Hepatitis C Patients

Introduction: In Egypt, HCC is now the first cause of cancer related mortality. This is attributed to the heavy burden of chronic HCV (CHC) infection. The increased risk to development of HCC in chronic HCV patients is largely restricted to cirrhotic patients and those with advanced fibrosis. Both FIB-4 and fibrosis index (FI) are considered non-invasive tools for evaluation of hepatic fibrosis, using simple variables. Aim of the Work: This work aims to examine the utility of FIB4 score and FI score in predicting the risk of HCC development in chronic HCV Egyptian patients. Patients and Methods: This study included 111 adult patients (100 males, 11 females) with chronic HCV and untreated HCC (group A) and 222 adult patients (128 males, 94 females) with chronic HCV without HCC (group B). FIB4 was estimated as follows: [Age x AST] / [Platelets x (ALT) 1/2]. FI was estimated as follows: 8.28- [ (0.01x Platelets (109/L) � (1.08* (10*serum albumin (gm/L)]. Results: FI and FIB4 scores reported statistically significant high values in group A. The values of FIB4 was 7.15 � 5.78 in group A compared to 3.42 � 3.14 in group B (P 0.000). The values of FI score was 3.57 � 1.07 in group A compared to 2.43 � 1.08 in group B (P0.000). The Stratified Specific LR for presence of HCC according to the score of FIB4 was (0.07, 1.22 and 2.43) in subjects with score (less than 2, 2 � 4 and 4) respectively. The SSLR concerning HCC presence according to FI score was (0.22, 1.02 and 5.05) in subjects with score (less than 2, 2 - 4 and 4) respectively. Conclusion: Both FI and FIB4 scores could be useful tools to predict the risk of development of HCC in Egyptian subjects with chronic HCV. Nevertheless, FI was superior to FIB4 in this aspect. FI 4 is 5.05 times as likely to occur in chronic HCV patients with HCC than those without. So, patients with chronic HCV with FI 4 must be subjected for meticulous follow-up.