title: The diagnostic value of non-invasive tests for the evaluation of liver fibrosis in chronic hepatitis B patients.
abstract: BACKGROUND
  Liver biopsy, which is considered the gold standard for the evaluation of hepatic fibrosis in patients with chronic hepatitis B (CHB), has certain limitations. The aim of this study was to investigate the diagnostic performance of non-invasive markers of hepatic fibrosis as potential alternatives to liver biopsy.
  
  
  METHODS
  The medical records of 221 patients with a diagnosis of CHB who underwent a liver biopsy were reviewed. Indirect indicators of fibrosis were calculated for each patient based on previously described formulas [Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), age-platelet index (API), cirrhosis discriminant score (CDS), AST-platelet ratio index (APRI), Forns index, FIB-4, Pohl score, AAR-platelet score (AARP), fibro-quotient (FibroQ), AST/platelet/Gammaglutamyl transpeptidase (GGT)/Alphafetoprotein (AFP) (APGA) index, Platelet/Age/Phosphatase (ALP)/AFP/AST (PAPAS) index, Lok's model, Goteborg University Cirrhosis Index (GUCI)]. Diagnostic adequacy of these indices was evaluated by receiver operating characteristic curve analysis.
  
  
  RESULTS
  Area under the receiver operating characteristic curves for the FIB-4, Forns, GUCI, APRI, PAPAS, APGA and FibroQ indices were 0.701, 0.680, 0.670, 0.670, 0.639, 0.638 and 0.588, respectively. The AAR, API, CDS and AARP indices, Pohl score and Lok's model were all deemed diagnostically inadequate. FIB-4 had the best diagnostic adequacy whereas AAR had the worst.
  
  
  CONCLUSIONS
  Our results suggest that out of the 13 indices evaluated, only FIB-4 index may be useful in estimating the extent of fibrosis in patients with CHB. There is a need for more comprehensive prospective studies to help determine the diagnostic value of non-invasive tests for liver fibrosis.
authors.affiliation: a Department of Clinical Biochemistry, Ankara Numune Training and Research Hospital , Ankara, Turkey.
authors.forename: Serpil
authors.initials: S
authors.lastname: Erdogan
authors.affiliation: a Department of Clinical Biochemistry, Ankara Numune Training and Research Hospital , Ankara, Turkey.
authors.forename: Halef Okan
authors.initials: HO
authors.lastname: Dogan
authors.affiliation: a Department of Clinical Biochemistry, Ankara Numune Training and Research Hospital , Ankara, Turkey.
authors.forename: Sevilay
authors.initials: S
authors.lastname: Sezer
authors.affiliation: a Department of Clinical Biochemistry, Ankara Numune Training and Research Hospital , Ankara, Turkey.
authors.forename: Sema
authors.initials: S
authors.lastname: Uysal
authors.affiliation: b Department of Clinical Pathology, Ankara Numune Training and Research Hospital , Ankara, Turkey.
authors.forename: Esra
authors.initials: E
authors.lastname: Ozhamam
authors.affiliation: b Department of Clinical Pathology, Ankara Numune Training and Research Hospital , Ankara, Turkey.
authors.forename: Serra
authors.initials: S
authors.lastname: Kayacetin
authors.affiliation: a Department of Clinical Biochemistry, Ankara Numune Training and Research Hospital , Ankara, Turkey.
authors.forename: Yuksel
authors.initials: Y
authors.lastname: Koca
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012372:ROC Curve; D012189:Retrospective Studies; D000509:alpha-Fetoproteins / Q000378:metabolism; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: C097353:AFP protein, human; D015415:Biomarkers; D000509:alpha-Fetoproteins; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase
keywords: Alanine aminotransferase; aspartate aminotransferase; chronic hepatitis B; liver fibrosis; platelet count