title: The diagnostic value of the FIB-4 index for staging hepatitis B-related fibrosis: a meta-analysis.
abstract: BACKGROUND
  Liver fibrosis stage is an important factor in determining prognosis and need for treatment in patients infected with hepatitis B virus (HBV). Liver biopsies are typically used to assess liver fibrosis; however, noninvasive alternatives such as the FIB-4 index have also been developed.
  
  
  OBJECTIVE
  To quantify the accuracy of the FIB-4 index in the diagnosis of HBV related fibrosis and cirrhosis.
  
  
  METHODS
  A meta-analysis of studies comparing the diagnostic accuracy of the FIB-4 index vs. liver biopsy in HBV-infected patients was performed using studies retrieved from the following databases: PubMed, Ovid, EMBASE, the Cochrane Library, the Chinese National Knowledge Infrastructure and the Chinese Biology Medicine disc. A hierarchical summary receiver operating curves model and bivariate model were used to produce summary receiver operating characteristic curves and pooled estimates of sensitivity and specificity. The heterogeneity was explored with meta-regression analysis. Publication bias was detected using Egger's test and the trim and fill method.
  
  
  RESULTS
  12 studies (N = 1,908) and 10 studies (N = 2,105) were included in the meta-analysis for significant fibrosis and cirrhosis, respectively. For significant fibrosis, the area under the hierarchical summary receiver operating curve (AUHSROC) was 0.78 (95% CI = 0.74-0.81). The recommended cutoff value was between 1.45 and 1.62, and the AUHSROC, summary sensitivity and specificity were 0.78 (95% CI = 0.74-0.81), 0.65 (95% CI = 0.56-0.73) and 0.77 (95% CI = 0.7-0.83), respectively. For cirrhosis, the AUHSROC was 0.89 (95% CI = 0.85-0.91). The recommended cutoff value was between 2.9 and 3.6, and the AUHSROC, summary sensitivity and specificity were 0.96 (95% CI = 0.92-1.00), 0.42 (95% CI = 0.36-0.48) and 0.96 (95% CI = 0.95-0.97), respectively. No publication bias was detected.
  
  
  CONCLUSIONS
  The FIB-4 index is valuable for detecting significant fibrosis and cirrhosis in HBV-infected patients, but has suboptimal accuracy in excluding fibrosis and cirrhosis.
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of the Medical College, Zhejiang University, Hangzhou, China.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of the Medical College, Zhejiang University, Hangzhou, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Laboratory Medicine, The First Affiliated Hospital of the Medical College, Zhejiang University, Hangzhou, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhao
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D006509:Hepatitis B / Q000097:blood / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D012680:Sensitivity and Specificity
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase