title: Prospective evaluation of FibroTest®, FibroMeter®, and HepaScore® for staging liver fibrosis in chronic hepatitis B: comparison with hepatitis C.
abstract: OBJECTIVE
  Fibrosis blood tests have been validated in chronic hepatitis C. Their diagnostic accuracy is less documented in hepatitis B. The aim of this study was to describe the diagnostic performance of FibroTest®, FibroMeter®, and HepaScore® for liver fibrosis in hepatitis B compared to hepatitis C.
  
  
  METHODS
  510 patients mono-infected with hepatitis B or C and matched on fibrosis stage were included. Blood tests were performed the day of the liver biopsy. Histological lesions were staged according to METAVIR.
  
  
  RESULTS
  Fibrosis stages were distributed as followed: F0 n=76, F1 n=192, F2 n=132, F3 n=54, F4 n=56. Overall diagnostic performance of blood tests were similar between hepatitis B and C with AUROC ranging from 0.75 to 0.84 for significant fibrosis, 0.82 to 0.85 for extensive fibrosis and 0.84 to 0.87 for cirrhosis. Optimal cut-offs were consistently lower in hepatitis B compared to hepatitis C, especially for the diagnosis of extensive fibrosis and cirrhosis, with decreased sensitivity and negative predictive values. More hepatitis B than C patients with F ⩾3 were underestimated: FibroTest®: 47% vs. 26%, FibroMeter®: 24% vs. 6%, HepaScore®: 41% vs. 24%, p<0.01. Multivariate analysis showed that hepatitis B (0R 3.4, 95% CI 1.2-19.2, p<0.02) and low γGT (OR 7.3, 95% CI 2.0-27.0, p<0.003) were associated with fibrosis underestimation.
  
  
  CONCLUSIONS
  Overall the diagnostic performance of blood tests is similar in hepatitis B and C. The risk of underestimating significant fibrosis and cirrhosis is however greater in hepatitis B and cannot be entirely corrected by the use of more stringent cut-offs.
authors.affiliation: Clinique Universitaire d'Hépato-Gastroentérologie, Pôle DIGIDUNE, CHU de Grenoble, France; Unité INSERM/Université Grenoble Alpes U823, IAPC Institut Albert Bonniot, Grenoble, France. Electronic address: VLeroy@chu-grenoble.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Leroy
authors.affiliation: Unité INSERM/Université Grenoble Alpes U823, IAPC Institut Albert Bonniot, Grenoble, France; Département d'Anatomie et cytologie Pathologiques, Pôle de Biologie, CHU de Grenoble, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Sturm
authors.affiliation: Département de Biologie Intégrée, Pole de Biologie, CHU de Grenoble, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Faure
authors.affiliation: GREPI TIMC, IMAG UMR CNRS 5525 Université Grenoble Alpes/Laboratoire d'Enzymologie, France.
authors.forename: Candice
authors.initials: C
authors.lastname: Trocme
authors.affiliation: Clinique Universitaire d'Hépato-Gastroentérologie, Pôle DIGIDUNE, CHU de Grenoble, France.
authors.forename: Alice
authors.initials: A
authors.lastname: Marlu
authors.affiliation: Clinique Universitaire d'Hépato-Gastroentérologie, Pôle DIGIDUNE, CHU de Grenoble, France; Unité INSERM/Université Grenoble Alpes U823, IAPC Institut Albert Bonniot, Grenoble, France.
authors.forename: Marie-Noëlle
authors.initials: MN
authors.lastname: Hilleret
authors.affiliation: GREPI TIMC, IMAG UMR CNRS 5525 Université Grenoble Alpes/Laboratoire d'Enzymologie, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Morel
authors.affiliation: Clinique Universitaire d'Hépato-Gastroentérologie, Pôle DIGIDUNE, CHU de Grenoble, France; Unité INSERM/Université Grenoble Alpes U823, IAPC Institut Albert Bonniot, Grenoble, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Zarski
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D005260:Female; D006403:Hematologic Tests / Q000379:methods; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000473:pathology*; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase
keywords: Blood tests; Cirrhosis; Diagnostic performance; Fibrosis; Non-invasive diagnosis