title: Prospective Comparison of Noninvasive Fibrosis Assessment to Predict Advanced Fibrosis or Cirrhosis in Asian Patients With Hepatitis C.
abstract: OBJECTIVE
  The diagnostic role of noninvasive fibrosis assessment, which can obviate liver biopsy in Asian patients with hepatitis C, remains controversial. This study aimed to evaluate the diagnostic accuracy of noninvasive fibrosis assessment to predict advanced fibrosis or cirrhosis in Asian patients with hepatitis C.
  
  
  METHODS
  A total of 101 antiviral treatment-naive patients with hepatitis C were prospectively enrolled between March 2011 and March 2013. Liver stiffness was measured by acoustic radiation force impulse (ARFI) elastography. At the same time, liver biopsy was performed to obtain histologic data of hepatic fibrosis. Diagnostic measurements of serum fibrosis indices and ARFI imaging were compared with predicted advanced fibrosis or cirrhosis by analyzing the area under the receiver operating characteristic (AUROC) curve.
  
  
  RESULTS
  The median age of the study population was 59 years (range, 25 to 82 y). Aspartate aminotransferase to alanine aminotransferase ratio (AAR), Fib-4, Forns index, aspartate aminotransferase to platelet ratio index (APRI), and Lok index showed significant, positive correlations with METAVIR stages (P<0.001). Fib-4 had the greatest AUROC for advanced fibrosis (≥F3) (0.864; 95% CI, 0.793-0.934), and the Lok index had the highest AUROC for predicting cirrhosis (F4) (0.847; 95% CI, 0.767-0.927). A tendency toward increasing liver stiffness existed in a graded manner across METAVIR stages (P<0.001).
  
  
  CONCLUSIONS
  Fib-4 and Lok index were useful noninvasive fibrosis indices for predicting advanced fibrosis and cirrhosis in Asian patients with hepatitis C. In addition, ARFI elastography exhibited acceptable diagnostic performance in the assessment of hepatic fibrosis in patients with hepatitis C.
authors.affiliation: Departments of *Internal Medicine †Pathology ‡Biostatistics §Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
authors.forename: Sae Kyung
authors.initials: SK
authors.lastname: Joo
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Kim
authors.forename: Sohee
authors.initials: S
authors.lastname: Oh
authors.forename: Byeong Gwan
authors.initials: BG
authors.lastname: Kim
authors.forename: Kook Lae
authors.initials: KL
authors.lastname: Lee
authors.forename: Hwi Young
authors.initials: HY
authors.lastname: Kim
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Jung
authors.forename: Hyun Sik
authors.initials: HS
authors.lastname: Woo
authors.forename: Min-Hoan
authors.initials: MH
authors.lastname: Moon
authors.forename: Mee Soo
authors.initials: MS
authors.lastname: Chang
authors.forename: Won
authors.initials: W
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D044466:Asian People; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy / Q000379:methods; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011446:Prospective Studies
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase