title: A prospective analysis of the prognostic value of biomarkers (FibroTest) in patients with chronic hepatitis C.
abstract: BACKGROUND
  FibroTest, a noninvasive method of measuring biomarkers of liver fibrosis, is an alternative to liver biopsy for determining the severity of chronic hepatitis C virus (HCV) infection. We compared the 5-year prognostic value of the FibroTest with biopsy staging for predicting cirrhosis decompensation and survival in patients with chronic HCV infection.
  
  
  METHODS
  Fibrosis stage was assessed on the same day by FibroTest and biopsy in a prospective cohort of 537 patients. Disease classification at baseline was 157 patients with severe fibrosis (FibroTest >0.58), 137 with moderate fibrosis (FibroTest 0.32-0.58), and 243 with no or minimal fibrosis (FibroTest <0.32).
  
  
  RESULTS
  In 64 untreated patients with severe fibrosis, survival without HCV complications was 73% [95% confidence interval (CI), 59%-086%; 13 complications], and survival without HCV-related death was 85% (95% CI, 73%-96%; 7 HCV deaths). Survival rates were higher in patients with moderate fibrosis, [99% (95% CI, 97%-100%; 1 complication; P <0.001) and 100% (no HCV death; P <0.001) for patients with and without HCV-related complications, respectively], and in patients with minimal fibrosis [100% (no complication; P <0.001 vs severe) and 100% (no HCV death; P <0.001 vs severe), respectively]. FibroTest was a better predictor than biopsy staging for HCV complications, with area under the ROC curves (AUROC) = 0.96 (95% CI, 0.93%-0.97%) vs 0.91 (95% CI, 0.85%-0.94%; P = 0.01), respectively; it was also a better predictor for HCV deaths: AUROC = 0.96 (95% CI, 0.93%-0.98%) vs 0.87 (95% CI, 0.70%-0.94%; P = 0.046), respectively. The prognostic value of FibroTest was still significant (P <0.001) in multivariate analyses after taking into account histology, treatment, alcohol consumption, and HIV coinfection.
  
  
  CONCLUSIONS
  The FibroTest measurement of HCV biomarkers has a 5-year prognostic value similar to that of liver biopsy.
authors.affiliation: Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, CNRS, Paris, France.
authors.forename: Yen
authors.initials: Y
authors.lastname: Ngo
authors.forename: Mona
authors.initials: M
authors.lastname: Munteanu
authors.forename: Djamila
authors.initials: D
authors.lastname: Messous
authors.forename: Frederic
authors.initials: F
authors.lastname: Charlotte
authors.forename: Françoise
authors.initials: F
authors.lastname: Imbert-Bismut
authors.forename: Dominique
authors.initials: D
authors.lastname: Thabut
authors.forename: Pascal
authors.initials: P
authors.lastname: Lebray
authors.forename: Vincent
authors.initials: V
authors.lastname: Thibault
authors.forename: Yves
authors.initials: Y
authors.lastname: Benhamou
authors.forename: Joseph
authors.initials: J
authors.lastname: Moussalli
authors.forename: Vlad
authors.initials: V
authors.lastname: Ratziu
authors.forename: Thierry
authors.initials: T
authors.lastname: Poynard
mesh_terms: D000410:Alanine Transaminase / Q000032:analysis; D000704:Analysis of Variance; D016632:Apolipoprotein A-I / Q000032:analysis; D001663:Bilirubin / Q000032:analysis; D015415:Biomarkers / Q000032:analysis; D005260:Female; D006242:Haptoglobins / Q000032:analysis; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008099:Liver / Q000737:chemistry; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016019:Survival Analysis; D000511:alpha-Macroglobulins / Q000032:analysis; D005723:gamma-Glutamyltransferase / Q000032:analysis
chemical_list: D016632:Apolipoprotein A-I; D015415:Biomarkers; D006242:Haptoglobins; D000511:alpha-Macroglobulins; D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase; D001663:Bilirubin