[Retrospective study of FibroScan, APRI, FIB-4 and FORNS indexes compared with liver biopsy in the evaluation of liver fibrosis in patients with chronic hepatitis C monoinfection and HIV coinfection].
OBJECTIVE
To assess the ability of FibroScan (FS) and the APRI, FIB-4 and FORNS indexes to predict liver fibrosis (LF), using liver biopsy as the gold standard.


METHODS
LF stage was determined in 154 patients with chronic hepatitis C virus infection using the METAVIR system. Fibroscan measurements and blood samples were taken simultaneously with biopsy. The tests were evaluated using ROC curves and the concordance, sensitivity, specificity and predictive values and likelihood ratios.


RESULTS
Significantly higher LF stages were found in older patients and in those with HIV coinfection. FS and FIB-4 were able to predict significant LF> or =1 and more than 94% of patients with FS>6.7 kPas or FIB-4>1.3 had LF> or =1 in liver biopsy, with low sensitivities (63% FS; 56% Fib-4). For the detection of LF> or =2, all the tests had significant predictive capacity and between 77% and 86% of the patients with FS>6.8 kPas, APRI>0.6, FIB-4>1.4 and FORNS>5.6 had LF> or =2, with low sensitivities (70%FS; 54%APRI; 59%FIB-4; 54%FORNS). All tests had high negative predictive values (91-92%) and specificities (86-92%) in the detection of advanced fibrosis (FH=4).


CONCLUSIONS
All tests were acceptable in predicting the presence or absence of mild fibrosis (LF> or =2) and the absence of advanced fibrosis (LF=2). However, the low or moderate agreement with liver biopsy and low sensitivities in the detection of mild fibrosis indicate that liver biopsy continues to be required when the results of other methods are discordant or indeterminate.
González Guilabert
Maria Isabel
MI
Unidad de Enfermedades Infecciosas, Hospital Clínico Universitario de Valladolid, Valladolid, España. isabel46@ono.com
Hinojosa Mena-Bernal
Carmen
C
del Pozo González
Jorge
J
del Pozo Pérez
Miguel Angel
MA
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D001706:Biopsy / Q000706:statistics & numerical data*; D002784:Cholesterol / Q000097:blood; D054459:Elasticity Imaging Techniques; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D005723:gamma-Glutamyltransferase / Q000097:blood
D015415:Biomarkers; D002784:Cholesterol; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase