title: Development of a non-invasive algorithm with transient elastography (Fibroscan) and serum test formula for advanced liver fibrosis in chronic hepatitis B.
abstract: BACKGROUND
  Non-invasive assessments of liver fibrosis in chronic hepatitis B were well established.
  
  
  OBJECTIVE
  To develop a combined algorithm of liver stiffness measurement (LSM) and serum test formula to predict advanced liver fibrosis in chronic hepatitis B.
  
  
  METHODS
  We reported an alanine aminotransferase (AST)-based LSM algorithm for liver fibrosis in 156 chronic hepatitis B patients, which formed the training cohort to evaluate the performance of APRI (AST-to-platelet-ratio-index), Forns index, FIB-4 and Fibroindex against liver histology. The best combined LSM-serum formula algorithm would be validated in another cohort of 82 chronic hepatitis B patients.
  
  
  RESULTS
  In the training cohort, LSM has the best performance of diagnosing advanced (> or =F3) fibrosis [area under the receiver operating characteristics curve (AUROC) 0.88, 95% confidence interval (CI) 0.85-0.91], while Forns index has the best performance among the various serum test formulae (AUROC 0.70, 95% CI 0.62-0.78). In the combined algorithm, low LSM or low Forns index could be used to exclude advanced fibrosis as both of them had high sensitivity (>90%). To confirm advanced fibrosis, agreement between high LSM and high Forns index could improve the specificity (from 99% to 100% and from 87% to 98% in the training and validation cohorts respectively).
  
  
  CONCLUSIONS
  A combined LSM-Forns algorithm can improve the accuracy to predict advanced liver fibrosis in chronic hepatitis B.
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China.
authors.forename: G L H
authors.initials: GL
authors.lastname: Wong
authors.forename: V W S
authors.initials: VW
authors.lastname: Wong
authors.forename: P C L
authors.initials: PC
authors.lastname: Choi
authors.forename: A W H
authors.initials: AW
authors.lastname: Chan
authors.forename: H L Y
authors.initials: HL
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood*; D000465:Algorithms; D019540:Area Under Curve; D054459:Elasticity Imaging Techniques; D005260:Female; D019694:Hepatitis B, Chronic / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D000410:Alanine Transaminase