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Original research
Validation of Novel Fibrosis Index (NFI) for assessment of liver fibrosis: comparison with transient elastography (FibroScan)
  1. Azhar Hussain1,
  2. Muhammad Asif Gul2,
  3. Muhammad Usama Khalid1
  1. 1 Ameer-ud-Din Medical College, PGMI, Lahore, Pakistan
  2. 2 Gastroenterology, Nishtar Medical College and Hospital, Multan, Pakistan
  1. Correspondence to Mr Azhar Hussain; azharnewton0786{at}


Background In this study, we collated cheap and readily available non-invasive biomarkers and FibroScan score in predicting fibrosis stages in chronic hepatitis C virus (HCV) infection.

Methods We studied 1898 patients with HCV infection confirmed by presence of HCV RNA in their serum. We compared the FibroScan score and fibrosis indices (FIs): aspartate transaminase (AST) to alanine transaminase (ALT) ratio (AAR), AST to Platelet Ratio Index (APRI), FI, fibrosis-4 (FIB-4), Age-Platelet Index (API), Pohl score, Fibrosis Cirrhosis Index (FCI). We developed a new FI, named Novel Fibrosis Index (NFI) calculated by the following formula: NFI=[(bilirubin×(ALP)2)/(platelet count (albumin)2)]−n.

Results AAR, APRI, FI, FIB-4, API, Pohl score, FCI and NFI were able to predict fibrosis stage with correlation coefficient indices 0.848, 0.711, 0.618, 0.741, 0.529, 0.360, 0.477 and 0.26, respectively. Receiver operating characteristic curves showed sensitivity and specificity for predicting F3 by NFI=75.1% and 41.1% and F4 for NFI=72.1% and 47.1%, AAR=62.8% and 37.6%, APRI=74.6% and 87.6%, FIB-4=53.2% and 72.3%, FI=78.1% and 92.3%, API=78.1% and 60%, Pohl score=38.1% and 78.1% and FCI=78.1% and 88.1%.

Conclusions Our NFI predicted F3 and has been found to have more sensitivity and specificity in predicting F4 fibrosis stage than other FIs.

  • hepatitis C
  • fibrosis
  • liver

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  • Contributors AH designed the study; collected, arranged data and contributed in statistical analysis of data and writing manuscript. MUK collected lab work’s data, compiled it, helped in designing the research, most importantly contributed in writing paper and critically analysing it. All work was performed under supervision of MAG including data collection. He also read manuscript critically and played a vital role in designing project. All authors approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by Institutional Ethical Review Board, Lahore General Hospital, Lahore, Pakistan.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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