Comparison of Eight Diagnostic Algorithms for Liver Fibrosis in Hepatitis C

Abstract

The sequential algorithm for fibrosis evaluation (SAFE) and the Bordeaux algorithm (BA), which cross–check FibroTest with the aspartate aminotransferase–to–platelet ratio index (APRI) or FibroScan, are very accurate but provide only a binary diagnosis of significant fibrosis (SAFE or BA for Metavir F ≥ 2) or cirrhosis (SAFE or BA for F4). Therefore, in clinical practice, physicians have to apply the algorithm for F ≥ 2, and then, when needed, the algorithm for F4 (“successive algorithms”). We aimed to evaluate successive SAFE, successive BA, and a new, noninvasive, detailed classification of fibrosis. The study included 1785 patients with chronic hepatitis C, liver biopsy, blood fibrosis tests, and FibroScan (the latter in 729 patients). The most accurate synchronous combination of FibroScan with a blood test (FibroMeter) provided a new detailed (six classes) classification (FM+FS). Successive SAFE had a significantly ( P < 10−3) lower diagnostic accuracy (87.3%) than individual SAFE for F ≥ 2 (94.6%) or SAFE for F4 (89.5%), and required significantly more biopsies (70.8% versus 64.0% or 6.4%, respectively, P < 10−3). Similarly, successive BA had significantly ( P ≤ 10−3) lower diagnostic accuracy (84.7%) than individual BA for F ≥ 2 (88.3%) or BA for F4 (94.2%), and required significantly more biopsies (49.8% versus 34.6% or 24.6%, respectively, P < 10−3). The diagnostic accuracy of the FM+FS classification (86.7%) was not significantly different from those of successive SAFE or BA. However, this new classification required no biopsy. Conclusion: SAFE and BA for significant fibrosis or cirrhosis are very accurate. However, their successive use induces a significant decrease in diagnostic accuracy and a significant increase in required liver biopsy. A new fibrosis classification that synchronously combines two fibrosis tests was as accurate as successive SAFE or BA, while providing an entirely noninvasive (0% liver biopsy) and more precise (six versus two or three fibrosis classes) fibrosis diagnosis. (Hepatology 2012;55:58–67)

The Prescribers’ Dilemma: Treatment of Hepatitis C Infection for Medicaid Insured Patients in United States

“…The non-invasive approaches include the evaluation of various laboratory parameters which are included in Fibrosure/Fibrotest, or in conjunction with liver stiffness evaluation by Fibroscan, which could obviate the need for liver biopsy with over 86.7% accuracy. 10 However, many medical centers still do not carry the Fibroscan or other liver stiffness measurement tools and are not able to conduct this testing with ease.…”

Nem invazív fibrosisdiagnosztika hepatitis C-vírus-infekcióban: szerepe a kezelés indikációjában, követésében és a prognózis megítélésében

“…A diagnosztikus érzé-kenység növelhető, ha két független módszert kombinálnak, például TE-t együtt szérummarker-vizsgálattal [15,22]. Papastergiou és mtsai szerint a TE akár 90%-ban feleslegessé teheti a biopsziát.…”

Bayesian prediction for liver fibrosis staging: Combined use of elastography and serum fibrosis markers

“…Algorithms for combined use of serum markers and elastography have been proposed, with specific cut-off values being used in the decision trees. [3][4][5] However, a cut-off value for staging always involves a compromise between sensitivity and specificity. The use of Bayesian prediction to stage liver fibrosis involves calculating the stage based on elastographic or serum biomarker measures (see Appendix).…”

“…On the other hand, BMSCs possess the ability to transdifferentiate into myofibroblasts that produce extracellular matrix (ECM) constituent and contribute to tissue repair. 3 One recent study demonstrated that acute liver failure triggered the activation of hepatic stellate cells and enhanced the formation of ECM, which reciprocally provide an optimal architecture for support of hepatocyte repopulation. 4 Among animals assigned to the intraportal transplantation group, an approximately and completely healthy liver structure was exhibited at weeks 3 and 5, respectively.…”