title: Performance of serum marker panels for liver fibrosis in chronic hepatitis C.
abstract: OBJECTIVE
  Chronic hepatitis C (CHC) is characterised by hepatic fibrosis, used as a proxy measure of prognosis. Liver biopsy is a flawed reference standard and serum markers of fibrosis offer an attractive alternative.
  
  
  METHODS
  A systematic review was conducted to assess the performance of panels of serum markers of hepatic fibrosis in CHC, incorporating analyses placing markers in a clinical context.
  
  
  RESULTS
  14 studies were included with 10 different panels. Median AUC in validation populations was 0.77 and training populations 0.81. Likelihood ratios (LR) ranged from -LR 0.1 to 0.9, + LR 1.2 to 33.1, diagnostic odds ratios (DOR) were 9.0 (median) with a range of 5 to 27- mostly below values of robust tests. Tests perform with either high sensitivity with low specificity or vice versa. Cut-off levels that gave clinically relevant predictive values for the presence/absence of significant fibrosis were applicable to 35% of the population.
  
  
  CONCLUSIONS
  Serum markers can rule-in or rule-out fibrosis in up to 35% of patients, but cannot differentiate stages of fibrosis reliably. Improvement of index and reference test in needed including evaluation of clinical outcomes as reference. Improved test reporting is needed to derive LR and DOR as performance indicators.
authors.affiliation: Public Health Sciences & Medical Statistics, University of Southampton, Level C South Academic Block, Southampton SO17 1BJ, UK. jules@soton.ac.uk
authors.forename: Julie
authors.initials: J
authors.lastname: Parkes
authors.forename: Indra Neil
authors.initials: IN
authors.lastname: Guha
authors.forename: Paul
authors.initials: P
authors.lastname: Roderick
authors.forename: William
authors.initials: W
authors.lastname: Rosenberg
mesh_terms: D015415:Biomarkers / Q000097:blood*; D018450:Disease Progression; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000209:etiology; D011379:Prognosis; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers