title: Diagnostic accuracy, reproducibility and robustness of fibrosis blood tests in chronic hepatitis C: a meta-analysis with individual data.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of liver fibrosis tests and its influencing factors in a meta-analysis with individual data.
  
  
  METHODS
  Four independent centers provided four blood tests and Metavir staging from 825 patients with chronic hepatitis C.
  
  
  RESULTS
  FibroMeter AUROC (0.840) for significant fibrosis was superior to those of Fibrotest (0.803, p=0.049), APRI (0.789, p=0.001) and Hepascore (0.781, p<0.001). The misclassification rate was lower for FibroMeter (23%) than for Fibrotest and Hepascore (both 28%, p<0.001). The variation in the diagnostic cut-offs of tests among centers, reflecting the overall reproducibility, was: FibroMeter: 4.2%, APRI: 24.0%, Fibrotest: 24.2%, Hepascore: 35.0%. Accordingly, the proportion of patients diagnosed with significant fibrosis changed: FibroMeter: 0.8%, Hepascore: 2.4% (p=0.02 vs FibroMeter), Fibrotest: 5.8% (p<10(-3)), APRI: 18.2% (p<10(-3)).
  
  
  CONCLUSIONS
  This study on clinical applicability shows significant differences in diagnostic accuracy, inter-center reproducibility, and robustness of biomarkers to changes in population characteristics between blood tests.
authors.affiliation: Clinique d'Hépato-Gastroentérologie, Pôle Digestif-DUNE, CHU, Grenoble, France. VLeroy@chu-grenoble.fr
authors.forename: Vincent
authors.initials: V
authors.lastname: Leroy
authors.forename: Philippe
authors.initials: P
authors.lastname: Halfon
authors.forename: Yannick
authors.initials: Y
authors.lastname: Bacq
authors.forename: Jérôme
authors.initials: J
authors.lastname: Boursier
authors.forename: Marie Christine
authors.initials: MC
authors.lastname: Rousselet
authors.forename: Marc
authors.initials: M
authors.lastname: Bourlière
authors.forename: Anne
authors.initials: A
authors.lastname: de Muret
authors.forename: Nathalie
authors.initials: N
authors.lastname: Sturm
authors.forename: Gilles
authors.initials: G
authors.lastname: Hunault
authors.forename: Guillaume
authors.initials: G
authors.lastname: Penaranda
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Bréchot
authors.forename: Candice
authors.initials: C
authors.lastname: Trocme
authors.forename: Paul
authors.initials: P
authors.lastname: Calès
mesh_terms: D005260:Female; D005355:Fibrosis; D006403:Hematologic Tests / Q000592:standards*; D019698:Hepatitis C, Chronic / Q000097:blood / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D008297:Male; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity