Comparison of simple tests for the non‐invasive diagnosis of clinically silent cirrhosis in chronic hepatitis C

Borroni, G.; Ceriani, Roberto L.; Cazzaniga, M.; Tommasini, M.; Roncalli, Massimo; Maltempo, C.; Felline, C.; Salerno, Francesco

doi:10.1111/j.1365-2036.2006.03034.x

Cited by 27 publications

(12 citation statements)

References 28 publications

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“…Based on the review of the literature, the following scores were calculated for each patient: FIB4 22, AST/ALT ratio, Cirrhosis Determinant Score 29 AST/Platelet ratio 30, Goteburg University Cirrhosis Index 31, AST to Platelet Ratio Index 32, BARD score 33 and NAFLD fibrosis score 16. The values for the upper limit of normal were set according to the International Federation of Clinical Chemistry: AST 35 U/L for men, 30 U/L for women, and were comparable to the values used in other analyses 34.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Noninvasive Markers of Fibrosis in Patients With Nonalcoholic Fatty Liver Disease

Shah

Lydecker

Murray

et al. 2009

Clinical Gastroenterology and Hepatology

1,252

1,124

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Background There is a need for a reliable and inexpensive noninvasive marker of hepatic fibrosis in nonalcoholic fatty liver disease (NAFLD). Aim To compare the performance of the FIB4 index (based on age, aspartate and alanine aminotransferase and platelet counts) with six other non-invasive markers of fibrosis in patients with NAFLD. Methods Using a nation-wide database of 541 adults with NAFLD, jackknife-validated areas under receiver operating characteristic curves (AUROC) of FIB4 and seven other markers were compared. The sensitivity at 90% specificity, 80% positive predictive value, and 90% negative predictive values were determined along with cutoffs for advanced fibrosis. Results The median FIB4 score was 1.11 (IQR=0.74–1.67). The jackknife-validated AUROC for FIB4 was 0.802 (95% CI: 0.758, 0.847) which was higher than that for the NAFLD fibrosis score (0.768 CI:0.720–0.816, p= 0.09), Goteburg University Cirrhosis Index (0.743, CI:0.695–0.791, p< 0.01), AST:ALT ratio (0.742, CI:0.690–0.794, p< 0.015), AST to platelet ratio index (0.730, CI:0.681–0.779, p< 0.001), AST to platelet ratio (0.720, 0.669–0.770, p< 0.001), BARD score (0.70, p< 0.001) and cirrhosis discriminant score (0.666, CI:0.614–0.718, p< 0.001). For a fixed specificity of 90% (FIB4 = 1.93), the sensitivity of identifying advanced fibrosis was only 50% (95% CI: 46, 55). A FIB4 ≥ 2.67 had an 80% positive predictive value and a FIB4 index ≤ 1.30 had a 90% negative predictive value. Conclusions The FIB4 index is superior to seven other non-invasive markers of fibrosis in patients with NAFLD; however its performance characteristics highlight the need for even better non-invasive markers.

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Section: Methodsmentioning

confidence: 99%

Comparison of Noninvasive Markers of Fibrosis in Patients With Nonalcoholic Fatty Liver Disease

Shah

Lydecker

Murray

et al. 2009

Clinical Gastroenterology and Hepatology

1,252

1,124

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“…A total of 540 articles from the MEDLINE search and 976 conference abstracts from the Searchlight database were identified. In total, 27 studies met the inclusion criteria, of which 21 were articles [8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] and six were abstracts [30][31][32][33][34][35]. One of the conference abstracts [32] had been published since the search was carried out and is hereafter referred to by the published paper only [36].…”

Section: Demographics and Study Characteristicsmentioning

confidence: 99%

“…Among studies using a platelet count definition for TCP, six different threshold levels were used; one study defined TCP as platelets £180 · 10 9 /L [30], one as platelets £175 · 10 9 /L [8], nine studies as platelets £150 · 10 9 /L [11,17,21,23,26,27,31,34,35], seven studies as platelets £140 · 10 9 /L [10,13,18,20,24,25,29], four studies as platelets £130 · 10 9 /L [12,16,19,33] and three studies as platelets £100 · 10 9 /L [14,22,28]. Two of the studies [ 15,36] defined TCP according to the ASH ITP Practice Guidelines [9].…”

Section: Platelets and Thrombocytopeniamentioning

confidence: 99%

“…Seven studies reported their study populations to be naïve to antiviral treatment [12][13][14]21,25,27,34]. The TCP prevalence in these studies was below 20% for two studies defining TCP as platelets £100 · 10 9 /L [14] and £130 · 10 9 /L [12], whereas the studies using the platelet definition of £150 · 10 9 /L [21,27,34], all reported a TCP prevalence of >29%.…”

Section: Antiviral Treatmentmentioning

confidence: 99%

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Prevalence of thrombocytopenia among patients with chronic hepatitis C: a systematic review

Louie

Micallef

Pimenta

et al. 2010

Journal of Viral Hepatitis

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Thrombocytopenia (TCP) is a haematological condition known to occur in chronically infected hepatitis C (HCV) patients and may interfere with diagnostic procedures, such as liver biopsy, because of risk of bleeding. It may also exclude patients from effective antiviral treatment. We conducted a systematic literature review of articles and conference abstracts, to assess the prevalence of TCP among those with HCV and to describe demographics, liver disease stage and treatment characteristics of these patients. Studies of individuals with confirmed chronic HCV infection were included in the review if the study had a clear definition of thrombocytopenia and a sample size of at least 50 subjects. The final selection included 27 studies (21 articles and six abstracts). The definitions of thrombocytopenia varied between studies and were based either on platelet counts, with threshold levels ranging between ≤ 100 × 10(9) and ≤ 180 × 10(9) /L, or on criteria set in haematological guidelines. The prevalence of TCP ranged from 0.16% to 45.4% and more than half of the studies reported a TCP prevalence of 24% or more. Because of the different TCP definitions, heterogeneity in study design and insufficient data on study characteristics such as age, gender, HCV treatment rates and disease severity an overall summary estimate of TCP prevalence among patients with HCV was not feasible. However, the relatively large prevalence in the majority of the studies suggests that there may be a substantial number of HCV patients at risk of bleeding complications and reduced likelihood of successful HCV antiviral treatment.

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“…12 These include the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), 13 AST/platelet ratio (APR), 14 the AST-to-platelet ratio index (APRI), 15 the BARD score, 16 the Goteburg University Cirrhosis Index (GUCI), 17 cirrhosis determinant score (CDS), 18 the simple panel, 4 the NAFLD fibrosis score, 8 and the FIB-4. 19 However, many of these tests were derived and validated in Caucasian.…”

Section: Introductionmentioning

confidence: 99%

Validation of P2/MS and Other Noninvasive Fibrosis Scoring Systems in the Korean Population with Nonalcoholic Fatty Liver Disease

Kim

Lee

et al. 2011

Korean J Gastroenterol

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Comparison of simple tests for the non‐invasive diagnosis of clinically silent cirrhosis in chronic hepatitis C

Abstract: SUMMARY BackgroundBiopsy is the gold standard for assessing cirrhosis in patients with chronic hepatitis C virus infection, but it is expensive and at risk of complications. Alternative non-invasive methods have been developed but their usefulness remains uncertain.

Cited by 27 publications

References 28 publications

Comparison of Noninvasive Markers of Fibrosis in Patients With Nonalcoholic Fatty Liver Disease

Comparison of Noninvasive Markers of Fibrosis in Patients With Nonalcoholic Fatty Liver Disease

Prevalence of thrombocytopenia among patients with chronic hepatitis C: a systematic review

Validation of P2/MS and Other Noninvasive Fibrosis Scoring Systems in the Korean Population with Nonalcoholic Fatty Liver Disease

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