Aim To assess concordance of eight frequently used serology-based scoring indices for liver fibrosis and cirrhosis with transient elastography (TE) in chronic hepatitis C (CHC) patients in order to determine serum indices with the highest concordance and clinical usability in clinical practice. Methods In this prospective study, 63 CHC patients were included and TE results were compared with eight non-invasive indices. The diagnostic performance of these tests was assessed using receiver operating characteristic curves with kappa index calculated for the concordance analysis. Results Median age of 63 patients was 54 years (interquartile range: 42 to 63); 27 (42.9%) were females. According to areas under the Receiver Operating Characteristics (AUROC), the best performing serum markers for significant liver fibrosis (METAVIR ≥F2), advanced liver fibrosis (≥F3) and cirrhosis (F4) determined by TE measurements (≥7.1kPa, ≥9.5kPa and ≥12kPa, respectively) were Fibrotest (AUROC=0.727 for ≥F2) and FIB-4 score (AUROC=0.779 for ≥F3 and AUROC=0.889 for F4). Fibrotest cut-off at >0.50 was concordant with TE for presence of significant fibrosis in 30 (out of 45; 66.7%), FIB-4 cut-off at <1.45 was concordant for absence of significant fibrosis in 13 (out of 18; 72.2%) and Goeteborg University Cirrhosis Index (GUCI) cut-off at >1 was concordant for presence of cirrhosis in 16 (out of 22; 72.7%) patients, but not for exclusion of cirrhosis. Conclusion Serology-based scoring indices had moderate overall concordance with TE. We propose that FIB-4 score, Fibrotest and GUCI be used in routine practice to exclude and diagnose significant fibrosis and diagnose cirrhosis, respectively.
Pimpin L, Cortez-Pinto H, Negro F, Coubould E, Lazarus J, Webber L, et al. EASL HEPAHE-ALTH Steering Committee. Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies. J Hepatol. 2018. p. 718–35.
2.
Petrovic J, Salkic N, Ahmetagic S, Stojic V, Mott-Divkovic S. Prevalence of chronic hepatitis B and hepatitis C among first time blood donors in Northeast Bosnia and Herzegovina: an estimate of prevalence in general population. Hepat Mon. 2011. p. 629–33.
3.
Leblebicioglu H, Arends J, Ozaras R, Corti G, Santos L, Boesecke C, et al. ESGHV (part of ESCMID). Availability of hepatitis C diagnostics and therapeutics in European and Eurasia countries. Antiviral Res. 2018. p. 9–14.
4.
Cadranel JF, Rufat P, Degos F. Practices of liver liopsy in France: results of a prospective nationwide survey. Hepatology. 2000. p. 477–81.
5.
Regev A, Berho M, Jeffers L, Milikowski C, Molina E, Pyrsopoulos N, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol. 2002. p. 2614–8.
6.
Bedossa P. Intraobserver and interobserver iariations in liver biopsy interpretation in patients with chronic hepatitis C. Hepatology. 1994. p. 15–20.
7.
Rousselet MC, Michalak S, Dupré F, Croué A, Bedossa P, Saint-André JP, et al. Sources of variability in histological scoring of chronic viral hepatitis. Hepatology. 2005. p. 257–64.
8.
Imbert-Bismut F, Ratziu V, Pieroni L, Benhamou C, Poynard Y, T. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet. 2001. p. 1069–75.
9.
Wai C. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003. p. 518–26.
10.
Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Venier D, et al. FIB-4: An inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology. 2007. p. 32–6.
11.
Forns X. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology. 2002. p. 986–92.
12.
Lin ZH, Xin YN, Dong QJ, Wang Q, Jiang XJ, Zhan SH, et al. Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: An updated meta-analysis. Hepatology. 2011. p. 726–36.
13.
Lok A, Ghany M, Goodman Z, Wright E, Everson G, Sterling R, et al. Predicting cirrhosis in patients with hepatitis C based on standard laboratory tests: Results of the HALT-C cohort. Hepatology. 2005. p. 282–92.
14.
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. p. 867–72.
15.
Hui A, Chan HY, Wong VS, Liew CT, Chim AL, Chan FL, et al. Identification of chronic hepatitis B patients without significant liver fibrosis by a simple noninvasive predictive model. Am J Gastroenterol. 2005. p. 616–23.
16.
Zarski JP, Sturm N, Guechot J, Paris A, Zafrani ES, Asselah T, et al. Comparison of nine blood tests and transient elastography for liver fibrosis in chronic hepatitis C: The ANRS HCEP-23 study. J Hepatol. 2012. p. 55–62.
17.
Friedrich-Rust M, Ong M, Martens S, Sarrazin C, Bojunga J, Zeuzem S, et al. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Gastroenterology. 2008. p. 960–74.
18.
Easl-Aleh. Clinical Practice Guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015. p. 237–64.
19.
Paranaguá-Vezozzo D, Andrade A, Mazo D, Nunes V, Guedes A, Ragazzo T, et al. Concordance of non-invasive mechanical and serum tests for liver fibrosis evaluation in chronic hepatitis C. World J Hepatol. 2017. p. 436.
20.
Leroy V, Halfon P, Bacq Y, Boursier J, Rousselet M, Bourlière M, et al. Diagnostic accuracy, reproducibility and robustness of fibrosis blood tests in chronic hepatitis C: a meta-analysis with individual data. Clin Biochem. 2008. p. 1368–76.
21.
Lee S, Lee A, Leibow N, Yang J, Soviero J, Gutekunst S, et al. Improved version 2.0 qualitative and quantitative Amplicor reverse transcription-PCR tests for hepatitis C virus RNA: calibration to international units, enhanced genotype reactivity, and performance characteristics. J Clin Microbiol. 2000. p. 4171–9.
22.
Bourliere M, Penaranda G, Renou C, Botta-Fridlund D, Portal T, Lecomte I, et al. Validation and comparison of indexes for fibrosis and cirrhosis prediction in chronic hepatitis C patients: proposal for a pragmatic approach classification without liver biopsies. J Viral Hepat. 2006. p. 659–70.
23.
Westin J, Ydreborg M, Islam S, Alsiö A, Dhillon A, Pawlotsky JM, et al. DITTO-HCV Study Group. A non-invasive fibrosis score predicts treatment outcome in chronic hepatitis C virus infection. Scand J Gastroenterol. 2008. p. 73–80.
24.
Poynard T, Morra R, Halfon P, Castera L, Ratziu V, Imbert-Bismut F, et al. Meta-analyses of FibroTest diagnostic value in chronic liver disease. BMC Gastroenterology. 2007.
25.
Shaheen A, Wan A, Myers R. FibroTest and Fi-broScan for the prediction of hepatitis C-related fibrosis: a systematic review of diagnostic test accuracy. Am J Gastroenterol. 2007. p. 2589–600.
26.
Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C. Hepatology. 2004. p. 48–54.
27.
Lucidarme D, Foucher J, Bail L, Vergniol B, Castera J, Duburque L, et al. Factors of accuracy of transient elastography (fibroscan) for the diagnosis of liver fibrosis in chronic hepatitis C. Hepatology. 2008. p. 1083–9.
28.
Castéra L, Vergniol J, Foucher J, Bail L, Chanteloup B, Haaser E, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology. 2005. p. 343–50.
29.
Delong E, Delong D, Dl CP. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988. p. 837–45.
30.
Agbim U, Asrani S. Non-invasive assessment of liver fibrosis and prognosis: an update on serum and elastography markers. Expert Rev Gastroenterol Hepatol. 2019. p. 361–74.
31.
Salkic N, Cickusic E, Jovanovic P, Denjagic M, Iljazovic-Topcic S, Bevanda M, et al. Online combination algorithm for non-invasive assessment of chronic hepatitis B related liver fibrosis and cirrhosis in resource-limited settings. Eur J Intern Med. 2015. p. 628–34.
32.
European Association for the Study of the Liver. EASL Recommendations on treatment of hepatitis C 2018. J Hepatol. 2018. p. 461–511.
33.
Pinzani M, Vizzutti F, Arena U, Marra F. Technology Insight: noninvasive assessment of liver fibrosis by biochemical scores and elastography. Nat Clin Pract Gastroenterol Hepatol. 2008. p. 95–106.
34.
Salkic N, Jovanovic P, Hauser G, Brcic M. Fibro-Test/Fibrosure for significant liver fibrosis and cirrhosis in chronic hepatitis B: a meta-analysis. Am J Gastroenterol. 2014. p. 796–809.
35.
Poynard T, Munteanu M, Imbert-Bismut F, Thabut C, D, Calvez L, et al. Prospective analysis of discordant results between biochemical markers and biopsy in patients with chronic hepatitis C. Clin Chem. 2004. p. 1344–55.
36.
Mehta S, Lau B, Afdhal N, Thomas D. Exceeding the limits of liver histology markers. J Hepatol. 2009. p. 36–41.
37.
Bedossa P, Dargere D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology. 2003. p. 1449–57.
38.
Calès P, Boursier J, Lebigot J, De Ledinghen V, Aubé C, Hubert I, et al. Liver fibrosis diagnosis by blood test and elastography in chronic hepatitis C: agreement or combination? Aliment Pharmacol Ther. 2017. p. 991–1003.
39.
Sebastiani G, Vario A, Guido M, Noventa F, Plebani M, Pistis R, et al. Stepwise combination algorithms of non-invasive markers to diagnose significant fibrosis in chronic hepatitis C. J Hepatol. 2006. p. 686–93.
40.
Sebastiani G. Non-invasive assessment of liver fibrosis in chronic liver diseases: Implementation in clinical practice and decisional algorithms. World J Gastroenterol. 2009. p. 2190.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
,
