Cirrhosis Probability in Hepatitis C MultiCalc

CDS = PlateletScore + ALTASTRatioScore + INRScore
LogOddsLok = (1.26 * AST / ALT) + (5.27 * INR) - (0.0089 * Platelets) - 5.56
LokIndex = e(LogOddsLok) / (1 + e(LogOddsLok))
GUCI = (AST / TopNormalAST) * INR * 100 / Platelets
APRI = (AST / TopNormalAST) * (100 / Platelets)
FIB4 = Age * AST / (Platelets * sqr(ALT))

Top Normal AST  

Lok Index  
Decimal Precision  


CDS Interpretation

0 to 7 Points: Cirrhosis less likely
8 to 11 Points: Cirrhosis more likely



Lok Index Interpretation

Fraction < 0.2: Cirrhosis less likely
Fraction >= 0.2 and <= 0.5: Indeterminate
Fraction > 0.5: Cirrhosis more likely



GUCI Interpretation

Point < 1: Cirrhosis less likely
Point >= 1: Cirrhosis more likely



APRI Interpretation

Points <= 0.5: Significant Fibrosis or Cirrhosis less likely
Point > 0.5 and <= 1: Significant Fibrosis indeterminate, Cirrhosis less likely
Points > 1 and <= 1.5: Significant Fibrosis more likely, Cirrhosis indeterminate
Points > 1.5 and <= 2: Significant Fibrosis more likely but Cirrhosis indeterminate
Points > 2: Significant Fibrosis and Cirrhosis more likely



FIB-4 Interpretation

Points < 1.45: Cirrhosis less likely
Points >= 1.45 and <= 3.25: Indeterminate
Points > 3.25: Cirrhosis more likely

  • Platelets is the platelet count. ALT is alanine aminotransferase. AST is aspartate aminotransferase and INR is the prothrombin time international normalized ratio.
  • Cirrhosis Discriminant Scores (CDS) >7 have a high predictive value of predicting cirrhosis with a specificity of >90%
  • In the Lok study, a Lok Index <0.2 missed only 7.8% of patients with cirrhosis while a Lok Index >0.5 misdiagnosed 14.8% of patients with cirrhosis.
  • In the Islam study, the Goteborg University Cirrhosis Index (GUCI) cutoff of 1.0 has a sensitivity of 80% and specificity of 78%.
  • Wai's AST to Platelet Ratio Index (APRI) cutoff values help predict both significant fibrosis and cirrhosis.
  • The FIB 4 index diagnostic cutoffs produce a negative predictive value of 94.7% with sensitivity 73.4%, and a positive predictive value of 82.1% with a specificity of 98.2%.

  1. Udell JA, Wang CS, Tinmouth J, et al. Does this patient with liver disease have cirrhosis?. JAMA. 2012 Feb 22;307(8):832-42. PubMed ID: 22357834 PubMed Logo
  2. Bonacini M, Hadi G, Govindarajan S, Lindsay KL. Utility of a discriminant score for diagnosing advanced fibrosis or cirrhosis in patients with chronic hepatitis C virus infection. Am J Gastroenterol. 1997 Aug;92(8):1302-4. PubMed ID: 9260794 PubMed Logo
  3. Lok AS, Ghany MG, Goodman ZD, et al. Predicting cirrhosis in patients with hepatitis C based on standard laboratory tests: results of the HALT-C cohort. Hepatology. 2005 Aug;42(2):282-92. PubMed ID: 15986415 PubMed Logo
  4. Islam S, Antonsson L, Westin J, Lagging M. Cirrhosis in hepatitis C virus-infected patients can be excluded using an index of standard biochemical serum markers. Scand J Gastroenterol. 2005 Jul;40(7):867-72. PubMed ID: 16109665 PubMed Logo
  5. Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003 Aug;38(2):518-26. PubMed ID: 12883497 PubMed Logo
  6. Vallet-Pichard A, Mallet V, Nalpas B, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology. 2007 Jul;46(1):32-6. PubMed ID: 17567829 PubMed Logo


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