The FibroTest value in discriminating between insignificant and significant fibrosis in chronic hepatitis C patients. The Romanian experience.
OBJECTIVE
To assess the diagnostic value of FibroTest to discriminate between insignificant and significant fibrosis in order to avoid the liver biopsy currently used for selection of chronic hepatitis C patients eligible for antiviral therapy.


METHODS
A retrospective study was carried out in 206 chronic hepatitis C patients with liver biopsy performed before starting antiviral therapy and concomitant serum stored at -80 degrees C. Liver fibrosis was evaluated according to the METAVIR scoring system on a scale of F0 to F4. Biochemical markers assessed were: alpha 2 macroglobulin (alpha 2-MG), apolipoprotein A1 (Apo-A1), haptoglobin (Hapto), gamma-glutamyltransferase (GGT), total bilirubin (TB). The FibroTest score was computed after adjusting for age and gender. Predictive values and ROC curves were used to assess the accuracy of FibroTest results.


RESULTS
Alpha 2-MG, apo-A1, Hapto and gender were independent predictors for significant fibrosis. For FibroTest the observed area under ROC (ObAUROC) for the discrimination between minimal or no fibrosis (F0-F1) and significant fibrosis (F2-F4) was 0.782 (+/- 95 CI: 0.716-0.847) for a cutoff value 0.47. The sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of the FibroTest to differentiate significant from insignificant fibrosis were 80.2; 63.2; 78.9 and 65.8, respectively. The adjusted AUROC (AdAUROC) according to the prevalence of each individual stage of fibrosis was 0.856.


CONCLUSIONS
FibroTest could be an alternative to biopsy in most patients with chronic hepatitis C. It requires a strict adherence and observance of the technical recommendations for the assays of biochemical markers in order to avoid analytical variability.
Grigorescu
Mircea
M
3rd Medical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Str. Croitorilor no. 19-21, 400162 Cluj-Napoca, Romania. mgrigorescu@umfcluj.ro
Rusu
Mihaela
M
Neculoiu
Daniela
D
Radu
Corina
C
Serban
Alexandru
A
Catanas
Mihaela
M
Grigorescu
Mircea Dan
MD
D000328:Adult; D000367:Age Factors; D000465:Algorithms; D016632:Apolipoprotein A-I / Q000097:blood; D001663:Bilirubin / Q000097:blood; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications* / Q000201:enzymology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012383:Romania; D012712:Serum Globulins / Q000378:metabolism; D012737:Sex Factors; D005723:gamma-Glutamyltransferase / Q000097:blood
D016632:Apolipoprotein A-I; D012712:Serum Globulins; D005723:gamma-Glutamyltransferase; D001663:Bilirubin