Simplified Cirrhosis Staging Algorithm for HCV Treatment Scale-up in Community Setting in Punjab, Pakistan

Abstract

Background: Pakistan has a high prevalence of the hepatitis C virus (HCV), but there is insufficient evidence and limited access to HCV treatment. Objectives: This study aimed to evaluate the diagnostic accuracy of non-invasive tests, including simple blood tests and hepatic ultrasonography (USG), in diagnosing cirrhosis among Hepatitis C (HCV) patients compared to Fibroscan. Methods: This retrospective cross-sectional study was conducted over one year from March 2022 to March 2023 at the Hepatitis Prevention and Treatment Clinic (HPTC), Lahore, Pakistan. The study included 844 HCV patients with positive polymerase chain reaction (PCR) results. Various parameters were analyzed, including liver function tests, Fibrosis-4 (FIB-4) index, AST to Platelet Ratio Index (APRI), USG results, and Fibrosis scores on Fibro-scan. A Liver Stiffness Measurement (LSM) of ≥12.5 kPa on Fibro-scan indicated cirrhosis. Statistical analysis was performed using SPSS version 26.0, and diagnostic performance was assessed through sensitivity, specificity, predictive values, and ROC curve analysis. Results: Based on LSM values, 28% of the patients were cirrhotic. Significant differences were observed in several parameters between cirrhotic and non-cirrhotic patients. When using APRI ≥1.50 or Fib-4 index ≥1.45 as cutoff values for cirrhosis, the combination showed sensitivity, specificity, and negative predictive values of 62% (C.I. 55.5-68.2%), 97% (C.I. 95.4–98.1), and 87%, respectively. Conclusion: A combination of APRI and FIB-4 demonstrated good diagnostic accuracy for determining cirrhotic status in HCV patients, while USG-documented chronic liver disease showed limited value in improving correct cirrhosis categorization.