title: Comparison of non-invasive assessment to diagnose liver fibrosis in chronic hepatitis B and C patients.
abstract: OBJECTIVE
  Chronic viral hepatitis B and C cause liver fibrosis, leading to cirrhosis. Fibrosis assessment is essential to establish prognosis and treatment indication. We compared seven non-invasive tests, separately and in combination, in chronic hepatitis patients to detect early stages of fibrosis according to the Metavir score in liver biopsy.
  
  
  METHODS
  Galactose and methacetin breath tests (GBT and MBT), biomarkers (hyaluronic acid (HA), aspartate aminotransferase platelet ratio index (APRI), FibroTest, and Fib-4) and transient elastography (TE) were evaluated in 89 patients. Additionally, 31 healthy controls were included for evaluation of breath tests and biomarkers.
  
  
  RESULTS
  Serum markers (HA, APRI, FibroTest, and Fib-4) and elastography significantly distinguished non-cirrhotic (F0123) from cirrhotic (F4) patients (p < 0.001, p = 0.015, p < 0.001, p = 0.005, p = 0.006, respectively). GBT, HA, APRI, FibroTest, Fib-4, and TE detected F01 from F234 (p = 0.04, p = 0.011, p = 0.009, p < 0.001, p < 0.001, and p < 0.001, respectively). A combination of different tests (TE, HA, and FibroTest) improved the performance statistically, area under the curve (AUC) = 0.87 for F234, 0.92 for F34, and 0.90 for F4.
  
  
  CONCLUSIONS
  HA, APRI, FibroTest, Fib-4, and TE reliably distinguish non-cirrhotic and cirrhotic patients. Except for MBT, all tests discriminate between mild and moderate fibrosis. As single tests: FibroTest, Fib-4, and TE were the most accurate for detecting early fibrosis; combining different non-invasive tests increased the accuracy for detection of liver fibrosis to such an extent and thus might be acceptable to replace liver biopsy.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
authors.forename: Krista J M
authors.initials: KJ
authors.lastname: Stibbe
authors.forename: Claudia
authors.initials: C
authors.lastname: Verveer
authors.forename: Jan
authors.initials: J
authors.lastname: Francke
authors.forename: Bettina E
authors.initials: BE
authors.lastname: Hansen
authors.forename: Pieter E
authors.initials: PE
authors.lastname: Zondervan
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Robert J
authors.initials: RJ
authors.lastname: de Knegt
authors.forename: Anneke J
authors.initials: AJ
authors.lastname: van Vuuren
mesh_terms: D000081:Acetamides / Q000032:analysis; D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D001792:Blood Platelets; D001944:Breath Tests; D054459:Elasticity Imaging Techniques; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005690:Galactose / Q000032:analysis; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D016014:Linear Models; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve
chemical_list: D000081:Acetamides; D015415:Biomarkers; C035495:methacetin; D006820:Hyaluronic Acid; D001219:Aspartate Aminotransferases; D005690:Galactose