Prospective comparison of six non-invasive scores for the diagnosis of liver fibrosis in chronic hepatitis C.
OBJECTIVE
Non-invasive markers of liver fibrosis have recently been developed as an alternative to liver biopsy. The aim of this study was to compare the diagnostic performance of 6 scores (MP3, Fibrotest, Fibrometer, Hepascore, Forns' score and APRI).


METHODS
We studied 180 chronic hepatitis C patients. Liver fibrosis was staged according to the METAVIR scoring system.


RESULTS
Overall diagnostic performance of scores determined by AUROCs ranged from 0.86 for Fibrometer to 0.78 for Forns' score (NS) for discriminating F0F1 versus F2F3F4. For discriminating F0F1F2 versus F3F4, AUROCs ranged from 0.91 for Fibrometer to 0.78 for Forns' score (p<0.02). Significant or extensive fibrosis was predicted in 10-86% of patients with positive predictive value (PPV) ranging from 55% to 94%. Using logistic regression, statistical independence was demonstrated for MP3, Fibrotest and APRI. Diagnostic performance of paired-combination scores was then evaluated. The best combinations could select one-third of patients for whom either absence of significant fibrosis or presence of extensive fibrosis could be predicted with more than 90% of certainty.


CONCLUSIONS
Current non-invasive scores give reliable information on liver fibrosis in one-third of chronic hepatitis C patients, especially when used in combination.
Leroy
Vincent
V
Département d'Hépato-gastroentérologie, CHU de Grenoble, BP 217, 38043 Grenoble cedex 9, France. VLeroy@chu-grenoble.fr
Hilleret
Marie-Noëlle
MN
Sturm
Nathalie
N
Trocme
Candice
C
Renversez
Jean-Charles
JC
Faure
Patrice
P
Morel
Françoise
F
Zarski
Jean-Pierre
JP
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000465:Algorithms; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D005234:Fatty Liver / Q000097:blood / Q000150:complications*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D005723:gamma-Glutamyltransferase / Q000097:blood
D015415:Biomarkers; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin