Stepwise combination algorithms of non-invasive markers to diagnose significant fibrosis in chronic hepatitis C

Sebastiani, Giada; Vario, Alessandro; Guido, Maria; Noventa, Franco; Plebani, Mario; Pistis, R.; Ferrari, Annachiara; Alberti, Alfredo

doi:10.1016/j.jhep.2006.01.007

Cited by 236 publications

(199 citation statements)

References 33 publications

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“…Finally, we have considered the accuracy of the APRI in isolation, rather than in combination with other measures. As reported by Sebastiani et al, 39 a stepwise algorithm including the APRI and other markers may improve diagnostic performance. Because of an absence of similar publications, we could not examine this issue.…”

Section: Discussionmentioning

confidence: 82%

“…Thirty-three studies examined the APRI in patients with chronic hepatitis C. Ultimately, 11 studies were excluded for duplication of data (n ϭ 1), 38 insufficient data (n ϭ 5), 11,[39][40][41][42] small sample size (n ϭ 2), 43,44 or failure to use biopsy as the reference test (n ϭ 3). [45][46][47] Thus, our final data set for the meta-analysis included 22 studies (Table 1).…”

Section: Search Resultsmentioning

confidence: 99%

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Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis C–related fibrosis: A systematic review

2007

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The development of noninvasive markers of liver fibrosis is a clinical and research priority. The aspartate aminotransferase-to-platelet ratio index (APRI) is a promising tool with limited expense and widespread availability. Our objective was to systematically review the performance of the APRI in hepatitis C virus (HCV)-infected patients. Random effects meta-analyses and areas under summary receiver operating characteristic curves (AUC) were examined to characterize APRI accuracy for significant fibrosis (stages 2-4) and cirrhosis. In 22 studies (n ‫؍‬ 4,266), the summary AUCs of the APRI for significant fibrosis and cirrhosis were 0.76 [95% confidence interval (CI), 0.74-0.79] and 0.82 (95%CI, 0.79-0.86), respectively. For significant fibrosis, an APRI threshold of 0.5 was 81% sensitive and 50% specific. At a 40% prevalence of significant fibrosis, this threshold had a negative predictive value (NPV) of 80%, but could reduce the necessity of liver biopsy by only 35%. For cirrhosis, a threshold of 1.0 was 76% sensitive and 71% specific. At a 15% cirrhosis prevalence, the NPV of this threshold was 91%. Higher APRI thresholds had suboptimal positive predictive values except in settings with a high prevalence of cirrhosis. APRI accuracy was not affected by the prevalence of advanced fibrosis, or study and biopsy quality. However, the accuracy for cirrhosis was greater in studies including human immunodeficiency virus (HIV)/HCV-co-infected patients. Conclusion: The major strength of the APRI is the exclusion of significant HCV-related fibrosis. Future studies of novel markers should demonstrate improved accuracy and cost-effectiveness compared with this economical and widely available index. (HEPATOLOGY 2007;46:912-921.)

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Section: Discussionmentioning

confidence: 82%

Section: Search Resultsmentioning

confidence: 99%

Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis C–related fibrosis: A systematic review

2007

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“…The key for future studies is to determine which combination of markers is the most reliable for first-line evaluation of fibrosis in HCV-infected patients and in what 25 found that a combination of APRI and FibroTest was accurate for the first-line evaluation of HCV-infected patients and improved the diagnostic performance, thus avoiding between 50% and 70% of LBs. More recently, Bourlière et al 26 showed that the combination of the APRI test, FibroTest, and Forns score in HCV-monoinfected patients allowed 191 of 235 (81.3%) patients to be correctly classified, thus avoiding LB.…”

Section: Discussionmentioning

confidence: 99%

Fib-4

et al. 2007

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“…They found that a stepwise application of these methods of assessing fibrosis could reduce the need for liver biopsy by 50%-70%. 69 The combined use of FibroTest and Fibroscan has also been evaluated. One study of 183 patients with HCV demonstrated an area under the ROC of 0.88 for F Ն 2, 0.95 for F Ն 3, and 0.95 for F Ն 4.…”

Section: Fibrotest and Fibrosurementioning

confidence: 99%