Prevalence of liver fibrosis and risk factors in a general population using non-invasive biomarkers (FibroTest).
BACKGROUND
FibroTest and elastography have been validated as biomarkers of liver fibrosis in the most frequent chronic liver diseases and in the fibrosis screening of patients with diabetes. One challenge was to use them for estimating the prevalence of fibrosis, identifying independent risk factors and to propose screening strategies in the general population.


METHODS
We prospectively studied 7,463 consecutive subjects aged 40 years or older. Subjects with presumed advanced fibrosis (FibroTest greater than 0.48) were re-investigated in a tertiary center.


RESULTS
The sample characteristics were similar to those of the French population. FibroTest was interpretable in 99.6%. The prevalence of presumed fibrosis was 2.8%, (209/7,463), including cirrhosis in 0.3% (25/7,463); 105/209 (50%) subjects with presumed fibrosis accepted re-investigation. Fibrosis was confirmed in 50, still suspected in 27, indeterminate in 25 and not confirmed with false positive FibroTest or false negative elastography in 3 subjects. False negative rate of FibroTest estimated using elastography was 0.4% (3/766). The attributable causes for confirmed fibrosis were both alcoholic and nonalcoholic fatty liver disease (NAFLD) in 66%, NAFLD in 13%, alcohol in 9%, HCV in 6%, and other in 6%. Factors independently associated (all P < 0.003) with confirmed fibrosis were age, male gender, waist circumference, HCV antibody and alcohol consumption estimated using carbohydrate-deficient transferrin, enabling efficient screening-oriented strategies to be compared and proposed.


CONCLUSIONS
Biomarkers have permitted to estimate prevalence of advanced fibrosis around 2.8% in a general population aged 40 years or older, and several risk factors which may be used for the validation of selective or non-selective screening strategies.
Poynard
Thierry
T
APHP-UPMC-Liver Center, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. tpoynard@teaser.fr
Lebray
Pascal
P
Ingiliz
Patrick
P
Varaut
Anne
A
Varsat
Brigitte
B
Ngo
Yen
Y
Norha
Pascal
P
Munteanu
Mona
M
Drane
Fabienne
F
Messous
Djamila
D
Bismut
Françoise Imbert
FI
Carrau
Jean Pierre
JP
Massard
Julien
J
Ratziu
Vlad
V
Giordanella
Jean Pierre
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016632:Apolipoprotein A-I / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D005602:France / Q000453:epidemiology; D006242:Haptoglobins / Q000378:metabolism; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D000511:alpha-Macroglobulins / Q000378:metabolism; D005723:gamma-Glutamyltransferase / Q000097:blood
D016632:Apolipoprotein A-I; D015415:Biomarkers; D006242:Haptoglobins; D000511:alpha-Macroglobulins; D005723:gamma-Glutamyltransferase; D001663:Bilirubin