Evaluation

 

 

Staging Fibrosis

• APRI (fibrosis scoring)

• FIB-4 (fibrosis scoring)

 

Staging Cirrhosis

• Encephalopathy

• Ascites

• History of esophageal varices and/or upper GI bleeding

• CPT (Child-Turcotte-Pugh) – severity of Cirrhosis (severe fibrosis)

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Fibrosis Calculations

APRI is ______ - https://www.omnicalculator.com/health/apri

FIB-4 is ______ - https://www.mdcalc.com/calc/2200/fibrosis-4-fib-4-index-liver-fibrosis

 

Use FIB-4 as an initial assessment. In chronic HCV, when combined with APRI, it has excellent negative predictive value for excluding advanced fibrosis. The positive predictive value is less clear.  

Note: Order liver elastography (FibroScan) for those with FIB-4 >1.5 and/or APRI >0.5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Clinically Assessing Encephalopathy

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Clinically Assessing Ascites

• Not Clinically Evident

• Mild - Moderate (Grade 1 or 2)

• Severe (Grade 3)

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​​Child-Turcotte-Pugh (CTP)  - https://www.mdcalc.com/calc/340/child-pugh-score-cirrhosis-mortality

 

 

 

 

 

 

 

 

 

 

 

 

 

Child Class A = Compensated Cirrhosis (Stage 1 or 2)

Child Class B = Decompensated Cirrhosis (Stage 3)

Child Class C = Severe Decompensated Cirrhosis (Stage 4)

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Fibroscan Results​​​

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Hepatitis B Panel - circle the appropriate indicator (negative or positive) for the 3 HBV tests below:

• HBsAG - Hepatitis B Surface Antigen with Reflex to Confirmation – negative or positive

• HBcAb (Anti-HBc) - Hepatitis B Core Antibody (IgM) – negative or positive

• HBsAb (Anti-HBs) - Hepatitis B Surface Antibody, Quantitative – negative or positive