Open Access Highly Accessed Research article

A comparison of four fibrosis indexes in chronic HCV: Development of new fibrosis-cirrhosis index (FCI)

Waqar Ahmad1, Bushra Ijaz1, Fouzia T Javed2, Sana Gull1, Humera Kausar1, Muhammad T Sarwar1, Sultan Asad1, Imran Shahid1, Aleena Sumrin1, Saba Khaliq1, Shah Jahan1, Asim Pervaiz1 and Sajida Hassan1*

Author Affiliations

1 Applied and Functional Genomics Lab, Centre of Excellence in Molecular Biology, University of the Punjab, Lahore-53700, Pakistan

2 Fouzia Tahir Javed, Department of Pathology, Jinnah Hospital, Lahore-54590, Pakistan

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BMC Gastroenterology 2011, 11:44  doi:10.1186/1471-230X-11-44

Published: 21 April 2011



Hepatitis C can lead to liver fibrosis and cirrhosis. We compared readily available non-invasive fibrosis indexes for the fibrosis progression discrimination to find a better combination of existing non-invasive markers.


We studied 157 HCV infected patients who underwent liver biopsy. In order to differentiate HCV fibrosis progression, readily available AAR, APRI, FI and FIB-4 serum indexes were tested in the patients. We derived a new fibrosis-cirrhosis index (FCI) comprised of ALP, bilirubin, serum albumin and platelet count. FCI = [(ALP × Bilirubin) / (Albumin × Platelet count)].


Already established serum indexes AAR, APRI, FI and FIB-4 were able to stage liver fibrosis with correlation coefficient indexes 0.130, 0.444, 0.578 and 0.494, respectively. Our new fibrosis cirrhosis index FCI significantly correlated with the histological fibrosis stages F0-F1, F2-F3 and F4 (r = 0.818, p < 0.05) with AUROCs 0.932 and 0.996, respectively. The sensitivity and PPV of FCI at a cutoff value < 0.130 for predicting fibrosis stage F0-F1 was 81% and 82%, respectively with AUROC 0.932. Corresponding value of FCI at a cutoff value ≥1.25 for the prediction of cirrhosis was 86% and 100%.


The fibrosis-cirrhosis index (FCI) accurately predicted fibrosis stages in HCV infected patients and seems more efficient than frequently used serum indexes.