The PAPAS index: a novel index for the prediction of hepatitis C-related fibrosis

Eur J Gastroenterol Hepatol. 2015 Aug;27(8):895-900. doi: 10.1097/MEG.0000000000000379.

Abstract

Background: Several noninvasive tests have been developed to determine the degree of hepatic fibrosis in patients with chronic hepatitis C (CHC) without performing liver biopsy.

Aim: This study aimed to determine the performance of the PAPAS (Platelet/Age/Phosphatase/AFP/AST) index in patients with CHC for the prediction of significant fibrosis and cirrhosis and to compare it with other noninvasive tests. To date, no study has evaluated the application of the PAPAS index in CHC-associated liver fibrosis.

Materials and methods: This retrospective study included 137 consecutive patients with CHC who had undergone a percutaneous liver biopsy before treatment. The aspartate aminotransferase/platelet ratio (APRI), aspartate aminotransferase/alanine transaminase ratio (AAR), age-platelet index (API), FIB4, cirrhosis discriminate score (CDS), the Göteborg University cirrhosis index (GUCI), and PAPAS were calculated and compared with the diagnostic accuracies of all fibrosis indices between the groups F0-F2 (no-mild fibrosis) versus F3-F6 (significant fibrosis) and F0-F4 (no cirrhosis) versus F5-F6 (cirrhosis).

Results: To predict significant fibrosis, the area under curve (95% confidence interval) for FIB4 was 0.727 followed by GUCI (0.721), PAPAS≈APRI≈CDS (0.716), and API (0.68). To predict cirrhosis, the area under curve (95% confidence interval) for FIB4 was calculated to be 0.735, followed by GUCI (0.723), PAPAS≈APRI≈CDS≈(0.71), and API (0.66). No statistically significant difference was observed among these predictors to exclude both significant fibrosis and cirrhosis (P>0.05).

Conclusion: The diagnostic capability of the PAPAS index has moderate efficiency and was not superior to other fibrosis markers for the identification of fibrosis in CHC patients. There is a need for more comprehensive prospective studies to help determine the diagnostic value of PAPAS for liver fibrosis.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Alanine Transaminase / blood
  • Alkaline Phosphatase / blood
  • Area Under Curve
  • Aspartate Aminotransferases / blood
  • Biomarkers / blood
  • Biopsy
  • Clinical Enzyme Tests
  • Decision Support Techniques*
  • Disease Progression
  • Female
  • Hepatitis C, Chronic / blood
  • Hepatitis C, Chronic / complications*
  • Hepatitis C, Chronic / diagnosis*
  • Humans
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / virology*
  • Male
  • Middle Aged
  • Platelet Count
  • Predictive Value of Tests
  • Prognosis
  • ROC Curve
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Turkey

Substances

  • Biomarkers
  • Aspartate Aminotransferases
  • Alanine Transaminase
  • Alkaline Phosphatase