Optimization and robustness of blood tests for liver fibrosis and cirrhosis.
OBJECTIVE
To optimize the performance and feasibility of fibrosis blood tests and evaluate their robustness.


METHODS
The derivation population included 1056 HCV patients with liver biopsy and blood markers. Validation populations included 984 patients with various viral hepatitis causes, and Fibroscan and/or liver biopsy and/or blood markers.


RESULTS
The bootstrap method validated the markers of the original FibroMeter(2G), but not those of Fibrotest and Hepascore, and provided a hyaluronate-free FibroMeter(3G). AUROCs for significant fibrosis were: FibroMeter(2G): 0.853 vs. FibroMeter(3G): 0.851, p=0.489. Compared to FibroMeter(2G), FibroMeter(3G) had a significantly higher patient rate with predictive values ≥90% for significant fibrosis. Accuracy for fibrosis stage classification was: Fibrotest: 37.9%, FibroMeter(2G): 74.9%, and FibroMeter(3G): 86.9% (p<10(-3)).


CONCLUSIONS
The bootstrap method validated FibroMeter(2G) and provided a cheaper and more feasible hyaluronate-free FibroMeter(3G) with comparable performance. Compared to binary diagnosis, fibrosis stage classification increased discrimination, with an increased accuracy to 87% for FibroMeter(3G).
Calès
Paul
P
Service d'Hépato-Gastroentérologie, CHU, Angers, France. paul.cales@univ-angers.fr
Boursier
Jérôme
J
Bertrais
Sandrine
S
Oberti
Frédéric
F
Gallois
Yves
Y
Fouchard-Hubert
Isabelle
I
Dib
Nina
N
Zarski
Jean-Pierre
JP
Rousselet
Marie Christine
MC
D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D015658:HIV Infections / Q000097:blood / Q000150:complications; D006403:Hematologic Tests / Q000379:methods*; D006526:Hepatitis C / Q000097:blood / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000145:classification / Q000175:diagnosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D015415:Biomarkers