title: A new combination of blood test and fibroscan for accurate non-invasive diagnosis of liver fibrosis stages in chronic hepatitis C.
abstract: OBJECTIVE
  Precise evaluation of the level of liver fibrosis is recommended in patients with chronic hepatitis C (CHC). Blood fibrosis tests and Fibroscan are now widely used for the non-invasive diagnosis of liver fibrosis. Detailed fibrosis stage classifications have been developed to provide an estimation of the liver fibrosis stage from the results of these non-invasive tests. Our aim was to develop a new and more accurate fibrosis stage classification by using new scores combining non-invasive fibrosis tests.
  
  
  METHODS
  In all, 729 patients with CHC (exploratory set: 349; validation set: 380) had liver biopsy for Metavir fibrosis (F) staging, and 6 fibrosis tests: Fibroscan, Fibrotest, FibroMeter, Hepascore, FIB-4, APRI.
  
  
  RESULTS
  Exploratory set: Fibroscan and FibroMeter were the independent predictors of different diagnostic targets of liver fibrosis. New fibrosis indexes combining FibroMeter and Fibroscan were thus developed for the diagnosis of clinically significant fibrosis (CSF-index) or severe fibrosis (SF-index). The association of CSF- and SF-indexes provided a new fibrosis stage classification (CSF/SF classification): F0/1, F1/2, F2 ± 1, F2/3, F3 ± 1, F4. Validation set: CSF/SF classification had a high diagnostic accuracy (85.8% well-classified patients), significantly higher than the diagnostic accuracies of FibroMeter (69.7%, P<0.001), Fibroscan (63.3%, P<0.001), or Fibrotest (43.9%, P<0.001) classifications.
  
  
  CONCLUSIONS
  The association of new fibrosis indexes combining FibroMeter and Fibroscan provides a new fibrosis stage classification. This classification is significantly more accurate than Fibrotest, FibroMeter, or Fibroscan classifications, and improves the accuracy of the non-invasive diagnosis of liver fibrosis stages to 86% without any liver biopsy.
authors.affiliation: Service d'Hépato-Gastroentérologie, CHU, Angers, France. jeboursier@chu-angers.fr
authors.forename: Jérôme
authors.initials: J
authors.lastname: Boursier
authors.forename: Victor
authors.initials: V
authors.lastname: de Ledinghen
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Zarski
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Rousselet
authors.forename: Nathalie
authors.initials: N
authors.lastname: Sturm
authors.forename: Juliette
authors.initials: J
authors.lastname: Foucher
authors.forename: Vincent
authors.initials: V
authors.lastname: Leroy
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fouchard-Hubert
authors.forename: Sandrine
authors.initials: S
authors.lastname: Bertrais
authors.forename: Yves
authors.initials: Y
authors.lastname: Gallois
authors.forename: Frédéric
authors.initials: F
authors.lastname: Oberti
authors.forename: Nina
authors.initials: N
authors.lastname: Dib
authors.forename: Paul
authors.initials: P
authors.lastname: Calès
mesh_terms: D000328:Adult; D054459:Elasticity Imaging Techniques; D005260:Female; D006403:Hematologic Tests; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index