title: Prospective validation of FibroTest in comparison with liver stiffness for predicting liver fibrosis in Asian subjects with chronic hepatitis B.
abstract: OBJECTIVE
  Diagnostic values of FibroTest (FT) for hepatic fibrosis have rarely been assessed in Asian chronic hepatitis B (CHB) patients. We aimed to validate its diagnostic performances in comparison with liver stiffness (LS).
  
  
  METHODS
  From 2008 to 2010, 194 CHB patients who underwent liver biopsies along with FT and transient elastography were prospectively enrolled. Fibrosis stage was assessed according to the Batts and Ludwig system.
  
  
  RESULTS
  To predict significant fibrosis (F≥2), advanced fibrosis (F≥3), and cirrhosis (F = 4), areas under receiver operating characteristic curves (AUROCs) of FT were 0.903, 0.907, and 0.866, comparable to those of LS (0.873, 0.897, and 0.910, respectively). Optimized cutoffs of FT to maximize sum of sensitivity and specificity were 0.32, 0.52, and 0.68 for F≥2, F≥3, and F = 4, while those of LS were 8.8, 10.2, and 14.1 kPa, respectively. According to FT and LS cutoffs, 123 (63.4%) and 124 (63.9%) patients were correctly classified consistent with histological fibrosis (F1, F2, F3, and F4), respectively. Overall concordance between each fibrosis stage estimated by FT and LS was observed in 111 patients, where 88 were correctly classified with histological results. A combination formula adding LS to FT (LS+FT) showed similar AUROC levels (0.885, 0.905, and 0.915), while another multiplying LS by FT (LS×FT) showed the best AUROCs (0.941, 0.931, and 0.929 for F≥2, F≥3, and F4, respectively).
  
  
  CONCLUSIONS
  FT provides good fibrosis prediction, with comparable outcomes to LS in Asian CHB patients. FT substantially reduces need for liver biopsy, especially when used in combination with LS.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Beom Kyung
authors.initials: BK
authors.lastname: Kim
authors.forename: Seung Up
authors.initials: SU
authors.lastname: Kim
authors.forename: Hyon Suk
authors.initials: HS
authors.lastname: Kim
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Park
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Ahn
authors.forename: Chae Yoon
authors.initials: CY
authors.lastname: Chon
authors.forename: In Rae
authors.initials: IR
authors.lastname: Cho
authors.forename: Dong-Hoo
authors.initials: DH
authors.lastname: Joh
authors.forename: Young Nyun
authors.initials: YN
authors.lastname: Park
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
mesh_terms: D000328:Adult; D016632:Apolipoprotein A-I / Q000097:blood; D019540:Area Under Curve; D044466:Asian People; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood / Q000378:metabolism; D001706:Biopsy; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D005260:Female; D006242:Haptoglobins / Q000378:metabolism; D006515:Hepatitis B virus; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D000511:alpha-Macroglobulins / Q000378:metabolism; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D016632:Apolipoprotein A-I; D015415:Biomarkers; D006242:Haptoglobins; D000511:alpha-Macroglobulins; D005723:gamma-Glutamyltransferase; D001663:Bilirubin