title: FibroQ: an easy and useful noninvasive test for predicting liver fibrosis in patients with chronic viral hepatitis.
abstract: BACKGROUND
  Liver biopsy-the gold standard in assessing liver histology-is recommended before all antiviral treatment. However, this procedure may cause complications, is costly, and is limited by sampling errors. Hence, noninvasive tests have been proposed to assess the severity of hepatic fibrosis. We propose a novel noninvasive index for predicting liver fibrosis, named fibro-quotient (FibroQ), and compared the diagnostic accuracies of FibroQ, aspartate aminotransferase (AST)-to-platelet ratio index (APRI), and AST/alanine aminotransferase (ALT) ratio (AAR).
  
  
  METHODS
  This retrospective cohort study included 140 consecutive patients with chronic viral hepatitis who had undergone percutaneous liver biopsy before treatment at the Chang Gung Memorial Hospital, Chiayi from May 2005 through December 2007. The clinical data including sex, age, AST, ALT, platelet count, prothrombin time (PT) international normalized ratio (INR), and the Metavir fibrosis score (F0 to F4) of liver histology were recorded. APRI, AAR, and FibroQ were calculated. Receiver operating characteristic (ROC) curves were constructed to compare the accuracies of these three noninvasive tests in predicting significant fibrosis in patients with chronic viral hepatitis.
  
  
  RESULTS
  FibroQ performed better than APRI, but was equal to AAR, in the prediction of significant fibrosis [area under the receiver operating characteristic curve (AUC): 0.783 vs 0.631 (p = 0.02) and 0.783 vs 0.733 (p = 0.26), respectively] and cirrhosis (AUC: 0.791 vs 0.634 (p = 0.03), and 0.791 vs 0.782 (p= 0.47), respectively). Using FibroQ below the lower cutoff value (0.6) and above the higher cutoff value (1.6), 108 of 140 (77.1%) patients could be identified correctly to have or not have significant fibrosis.
  
  
  CONCLUSIONS
  FibroQ, a novel noninvasive test, is an useful and easy tool to evaluate liver fibrosis in patients with chronic viral hepatitis and has better accuracy than APRI and is equal to AAR. Further prospective studies are warranted to validate its efficacy.
authors.affiliation: Department of Gastroenterolgy and Hepatology, Chang Gung Memorial Hospital at Chiayi, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Yung-Yu
authors.initials: YY
authors.lastname: Hsieh
authors.forename: Shui-Yi
authors.initials: SY
authors.lastname: Tung
authors.forename: I-Lin
authors.initials: IL
authors.lastname: Lee
authors.forename: Kamfai
authors.initials: K
authors.lastname: Lee
authors.forename: Chien-Heng
authors.initials: CH
authors.lastname: Shen
authors.forename: Kuo-Liang
authors.initials: KL
authors.lastname: Wei
authors.forename: Te-Sheng
authors.initials: TS
authors.lastname: Chang
authors.forename: Chia-Sheng
authors.initials: CS
authors.lastname: Chuang
authors.forename: Cheng-Shyong
authors.initials: CS
authors.lastname: Wu
authors.forename: Yi-Hsiung
authors.initials: YH
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006521:Hepatitis, Chronic / Q000150:complications*; D006525:Hepatitis, Viral, Human / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase