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

AimAssessment of liver fibrosis in chronic hepatitis C (CHC) patients is necessary before antiviral treatment. This study aimed to evaluate the effectiveness of eight non‐invasive models (aspartate aminotransferase [AST]/alanine transaminase ratio [AAR], AST/platelet ratio index [APRI], fibrosis–cirrhosis index [FCI], fibrosis index [FI], fibrosis‐4 [FIB‐4] score, fibrosis quotient [FibroQ], King, and von Willebrand factor antigen (vWF‐Ag)/thrombocyte ratio [VITRO] scores) for predicting fibrosis compared with liver biopsy and to create a new score for predicting different fibrosis stages with increased accuracy.MethodsWe prospectively studied 127 treatment‐naive CHC patients who underwent liver biopsy. The 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 vWF‐Ag, AST, and platelets: [VAP = (AST (U/L) × vWF‐Ag)/platelets (109/L)].ResultsApart 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 area under the receiver operating characteristic curve, with 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% positive predictive value for predicting mild fibrosis. At a cut‐off value >2.3 for predicting cirrhosis, VAP had 73% sensitivity and 81.7% positive predictive value.ConclusionsThe 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 antivirals.