External validation of aMAP risk score in patients with chronic hepatitis C genotype 4 and cirrhosis who achieved SVR following DAAs

We read with interest the article by Fan et al.,[1]Fan R. Papatheodoridis G. Sun J. Innes H. Toyoda Xie Q. al.A MAP risk score predicts hepatocellular carcinoma development in patients chronic hepatitis.J Hepatol. 2020; 73: 1368-1378Abstract Full Text PDF PubMed Scopus (38) Google Scholar wherein they developed an (HCC) called aMAP based on 5 parameters; age, male sex, albumin–bilirubin (ALBI), and platelet count. The was used to evaluate HCC 17,347 hepatitis of different etiologies. Cut-off values 50 60 were best for stratifying a low, medium or high HCC. A cut-off value resulted sensitivity 85.7–100% negative predictive (NPV) 99.3–100%, while specificity 56.6–95.8% positive (PPV) 6.6–15.7%.[1]Fan Accurate models are urgently required guide individualized management HCV-related cirrhosis, who increasingly being treated very effective safe direct-acting antivirals (DAAs).[2]Shiha Esmat Hassany M. Soliman Elbasiony Fouad al.Ledipasvir/sofosbuvir without ribavirin 8 12 weeks treatment HCV genotype 4 infection: results from randomised phase III study Egypt.Gut. 2019 Apr; 68: 721-728Crossref (22) Scholar,[3]Shiha El-Basiouny Mikhail N.N.H. Sofosbuvir plus treatment-Naïve patients: real-life experience.MJVH. 2016 November; 2: 1-8Google performance reported cohorts promising, however, we think that several points require clarification. First, cirrhosis is important factor HCC, but it not well represented authors’ training cohort (19.3%) nor validation (19.8%), number low external (ranging 11.4% 27.4%). It clear what extent this could affect model as scores usually derived greater incidence cirrhosis.4Alonso S. Manzano M.L. Gea F. Ahumada A.M. Devesa M.J. Olveira A. non-invasive markers after viral response HCV-advanced fibrosis.Hepatology. 2020 Oct 6; Crossref (25) Scholar, 5Sharma S.A. Kowgier Hansen B.E. Brouwer W.P. Maan Wong D. al.Toronto index: validated scoring system predict 10-year cirrhosis.J 2017 Aug 24; S0168-8278 (32248-1)Google 6Shiha Waked I. Gomaa al.GES: simple HCV-GT4 associated advanced liver fibrosis oral antivirals.Liver Int. Nov; 40: 2828-2833Crossref (14) Second, authors did report changes sustained virologic (SVR). These be more than baseline calculation.[4]Alonso Scholar,[7]Huang C.F. Yeh Huang C. Liang P.C. Lin Y.H. Chen S.C. al.Post-treatment fibrotic modifications overwhelm pretreatment predicting CHC curative antivirals.Hepatol 2018 12: 544-551Crossref (7) Evaluation post-treatment setting will only reflect laboratory variables may also enhance accuracy clinical practice. Third, comparison other existing performed B. Comparison published C required. In authors' recommendation patient populations ethnicities, attempted validate 2,085 4, (F4) (F3), achieved SVR following DAAs recruited Egyptian Liver Research Institute Hospital (ELRIAH) its satellites between January 2015 August 2017; average duration follow-up 4–23 months end treatment. Using score, our stratified into low-, intermediate- high-risk groups: 329 (15.8%), 890 (42.7%) 866 (41.5%), respectively. 98.6 (95% CI 92.3–99.8) NPV 99.7 98.3–99.9). 60.0 57.8–92.1) PPV 6.9 5.4–8.8). Patients low-risk had 1-year cumulative 0.0%, 2-year 0.1%, 3-year 0.1%. intermediate-risk group 0.4%, 0.5%. 0.3%, 2.1%, 3.3%. (Fig. 1). showed able stratify intermediate-, groups. Harrell’s c statistic 0.713. valid couple must considered. 84% categorized at intermediate risk, which means surveillance would avoided patients. This reduce cost-effectiveness programs impose substantial physical harms (e.g. multiple CT/MRI scans[8]Atiq O. Tiro Yopp A.C. Muffler Marrero J.A. Parikh N.D. al.An assessment benefits cirrhosis.Hepatology. 65: 1196-1205Crossref (107) Scholar,[9]Singal A.F. Patibandla Obi Fullington al.Benefits prospective cirrhosis.Clin Gastroenterol Sep 10; S1542-3565: 31270-31272Google Scholar). (6.9%) suboptimal (60.0%). suggested combining (such stiffness measurement, circulating cell-free DNA signatures, proteins, metabolites) further improve among group. believe adding sophisticated tests make expensive difficult implemented real life Simpler readily available preferable score. Public donation ELRIAH. All drafted paper provided input manuscript approved final version. declare no conflicts interest. Please refer accompanying ICMJE disclosure forms details. is/are supplementary data article: Download .pdf (.16 MB) Help pdf files Multimedia component 1 hepatitisJournal HepatologyVol. 73Issue 6PreviewHepatocellular leading cause death hepatitis. international collaboration, sought develop global universal Full-Text Open AccessReply to: “External DAAs”Journal 74Issue 4PreviewWe thank Prof. Shiha al. their work (SVR) Egypt.1