Comparison of blood tests for liver fibrosis specific or not to NAFLD.
OBJECTIVE
To compare blood tests of liver fibrosis specific for NAFLD: the FibroMeter NAFLD and the NAFLD fibrosis score (NFSA) with a non-specific test, APRI.


METHODS
Two hundred and thirty-five NAFLD patients with liver Metavir staging and blood markers from two independent centres were randomly assigned to a test (n=121) or a validation population (n=114).


RESULTS
The highest accuracy--91%--for significant fibrosis was obtained with the FibroMeter whose (i) AUROC (0.943) was significantly higher than those of NFSA (0.884, p=0.008) and APRI (0.866, p<10(-3); p=0.309 vs NFSA) in the whole population, and (ii) misclassification rate (9%) was significantly lower than those of NFSA (14%, p=0.04) and APRI (16%, p=0.002) and did not vary according to centre (14 vs 7%, p=0.07), unlike those of NFSA (25 vs 9%, p=0.001) and APRI (29 vs 11%, p<10(-3)). By using thresholds of 90% predictive values, liver biopsy could have been avoided in most patients: FibroMeter: 97.4% vs NFSA: 86.8% (p<10(-3)) and APRI: 80.0% (p<10(-3)). A new classification provided three reliable diagnosis intervals: F0/1, F0/1/2, F2/3/4 with 91.4% accuracy for FibroMeter, avoiding biopsy in all patients.


CONCLUSIONS
FibroMeter NAFLD had high performance and provided reliable diagnosis for significant fibrosis, significantly outperforming NFSA and APRI.
Calès
Paul
P
Service d'Hépato-Gastroentérologie, CHU, 49933 Angers Cedex 09, France. paul.cales@univ-angers.fr
Lainé
Fabrice
F
Boursier
Jérôme
J
Deugnier
Yves
Y
Moal
Valérie
V
Oberti
Frédéric
F
Hunault
Gilles
G
Rousselet
Marie Christine
MC
Hubert
Isabelle
I
Laafi
Jihane
J
Ducluzeaux
Pierre Henri
PH
Lunel
Françoise
F
D000328:Adult; D000465:Algorithms; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D005234:Fatty Liver / Q000097:blood* / Q000175:diagnosis*; D005260:Female; D006403:Hematologic Tests / Q000379:methods*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012680:Sensitivity and Specificity
D001219:Aspartate Aminotransferases