title: Noninvasive biomarkers FibroTest and ActiTest versus liver biopsy in chronic hepatitis C patients: the Middle East experience.
abstract: BACKGROUND
  The aim of this study was to compare noninvasive biomarkers, FibroTest and ActiTest in predicting fibrosis stage and inflammation grade in chronic hepatitis C (CHC) patients with liver biopsy (LB).
  
  
  METHODS
  In 107 patients with CHC, levels of six serum biomarkers (alanine aminotransferase, γ-glutamyl transpeptidase, total bilirubin, haptoglobin, apolipoprotein, α-2 macroglobulin) were determined at the time of LB. LB was evaluated by Metavir score for fibrosis and inflammation. Voluntary blood donors (n=106) were taken as controls for the study.
  
  
  RESULTS
  Fibrosis estimated by Fibrotest was significantly higher in patients compared to control group. The observed area under the receiver operating characteristic curve (AUROC) for advanced fibrosis (F3, F4) adjusted according to the observed difference between advanced and non-advanced fibrosis prevalence (DANA) was 0.80 (0.69-0.88) and the AUROC for cirrhosis (F4) was 0.94 (0.86-0.98). ActiTest AUROC for moderate to severe activity (A2A3) was 0.72 (0.61-0.81), and for severe activity (A3) was 0.88 (0.78-0.93). The diagnostic values in the group of good quality biopsy (n=41) showed Fibrotest AUROC (DANA-adjusted): for advanced fibrosis 0.90 (0.72-0.99); for cirrhosis 0.93 (0.76-0.98); and ctiTest AUROC: for moderate/severe activity 0.86 (0.67-0.94); and for severe activity 0.90 (0.76-0.93). There was good concordance between FibroTest and LB (with discordance for two or more stages in <20% for advanced fibrosis and <10% for cirrhosis) and between ActiTest and LB. Specificity for FibroTest and ActiTest in the control population were 95% and 100% respectively.
  
  
  CONCLUSIONS
  Fibrotest and ActiTest had high observed and standardized diagnostic values for predicting fibrosis and activity respectively.
authors.affiliation: Division of Gastroenterology and Hepatology (Rafie Yakoob, Ragesh Babu Thandassery, Moutaz F. Derbala, Muneera J. Al Mohannadi, Anil K. John, Manik Sharma, Hamidulla Wani, Saad Al Kaabi), Hamad General Hospital, Doha, Qatar.
authors.forename: Rafie
authors.initials: R
authors.lastname: Yakoob
authors.affiliation: Department of Laboratory Medicine and Pathology (Issam Al Bozom), Hamad General Hospital, Doha, Qatar.
authors.forename: Issam Al
authors.initials: IA
authors.lastname: Bozom
authors.affiliation: Division of Gastroenterology and Hepatology (Rafie Yakoob, Ragesh Babu Thandassery, Moutaz F. Derbala, Muneera J. Al Mohannadi, Anil K. John, Manik Sharma, Hamidulla Wani, Saad Al Kaabi), Hamad General Hospital, Doha, Qatar.
authors.forename: Ragesh Babu
authors.initials: RB
authors.lastname: Thandassery
authors.affiliation: Department of Biochemistry (Mohamed Osman Abdel Rahman), Hamad General Hospital, Doha, Qatar.
authors.forename: Mohamed Osman Abdel
authors.initials: MO
authors.lastname: Rahman
authors.affiliation: Division of Gastroenterology and Hepatology (Rafie Yakoob, Ragesh Babu Thandassery, Moutaz F. Derbala, Muneera J. Al Mohannadi, Anil K. John, Manik Sharma, Hamidulla Wani, Saad Al Kaabi), Hamad General Hospital, Doha, Qatar.
authors.forename: Moutaz F
authors.initials: MF
authors.lastname: Derbala
authors.affiliation: Division of Gastroenterology and Hepatology (Rafie Yakoob, Ragesh Babu Thandassery, Moutaz F. Derbala, Muneera J. Al Mohannadi, Anil K. John, Manik Sharma, Hamidulla Wani, Saad Al Kaabi), Hamad General Hospital, Doha, Qatar.
authors.forename: Muneera J Al
authors.initials: MJ
authors.lastname: Mohannadi
authors.affiliation: Division of Gastroenterology and Hepatology (Rafie Yakoob, Ragesh Babu Thandassery, Moutaz F. Derbala, Muneera J. Al Mohannadi, Anil K. John, Manik Sharma, Hamidulla Wani, Saad Al Kaabi), Hamad General Hospital, Doha, Qatar.
authors.forename: Anil K
authors.initials: AK
authors.lastname: John
authors.affiliation: Division of Gastroenterology and Hepatology (Rafie Yakoob, Ragesh Babu Thandassery, Moutaz F. Derbala, Muneera J. Al Mohannadi, Anil K. John, Manik Sharma, Hamidulla Wani, Saad Al Kaabi), Hamad General Hospital, Doha, Qatar.
authors.forename: Manik
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Division of Gastroenterology and Hepatology (Rafie Yakoob, Ragesh Babu Thandassery, Moutaz F. Derbala, Muneera J. Al Mohannadi, Anil K. John, Manik Sharma, Hamidulla Wani, Saad Al Kaabi), Hamad General Hospital, Doha, Qatar.
authors.forename: Hamidulla
authors.initials: H
authors.lastname: Wani
authors.affiliation: Division of Gastroenterology and Hepatology (Rafie Yakoob, Ragesh Babu Thandassery, Moutaz F. Derbala, Muneera J. Al Mohannadi, Anil K. John, Manik Sharma, Hamidulla Wani, Saad Al Kaabi), Hamad General Hospital, Doha, Qatar.
authors.forename: Saad Al
authors.initials: SA
authors.lastname: Kaabi
keywords: ActiTest; Fibrotest; Liver biopsy; hepatitis C virus
references.citation: Gastroenterology. 2005 Feb;128(2):343-50
references.pmid: 15685546
references.citation: Hepatology. 2002 Oct;36(4 Pt 1):986-92
references.pmid: 12297848
references.citation: J Hepatol. 2011 Aug;55(2):245-64
references.pmid: 21371579
references.citation: Egypt J Immunol. 2011;18(2):1-12
references.pmid: 23082465
references.citation: Clin Chem. 2005 Oct;51(10):1867-73
references.pmid: 16055434
references.citation: Clin Chem Lab Med. 2004 Mar;42(3):323-33
references.pmid: 15080567
references.citation: Hepatology. 2004 Mar;39(3):862-3; author reply 863
references.pmid: 14999708
references.citation: J Hepatol. 2009 Jan;50(1):36-41
references.pmid: 19012989
references.citation: Clin Chem. 2007 Sep;53(9):1615-22
references.pmid: 17634213
references.citation: Gut. 2003 Dec;52(12):1784-7
references.pmid: 14633963
references.citation: Gastroenterol Clin Biol. 2009 Feb;33(2):126-32
references.pmid: 19193508
references.citation: J Hepatol. 2003 Aug;39(2):239-44
references.pmid: 12873821
references.citation: J Hepatol. 2004 Dec;41(6):935-42
references.pmid: 15582126
references.citation: Hepatology. 2002 Nov;36(5 Suppl 1):S3-20
references.pmid: 12407572
references.citation: J Hepatol. 2014 Feb;60(2):392-420
references.pmid: 24331294
references.citation: Am J Gastroenterol. 2006 Mar;101(3):547-55
references.pmid: 16542291
references.citation: Saudi J Gastroenterol. 2008 Oct;14(4):163-73
references.pmid: 19568532
references.citation: Hepatology. 2005 Dec;42(6):1373-81
references.pmid: 16317693
references.citation: Can J Gastroenterol. 2012 Jun;26(6):359-75
references.pmid: 22720279
references.citation: J Hepatol. 2007 May;46(5):775-82
references.pmid: 17321634
references.citation: Clin Chem. 2004 Aug;50(8):1299-300
references.pmid: 15277345
references.citation: Hepatology. 1996 Aug;24(2):289-93
references.pmid: 8690394
references.citation: J Hepatol. 2006 Apr;44(4):686-93
references.pmid: 16490278
references.citation: Lancet. 2001 Apr 7;357(9262):1069-75
references.pmid: 11297957
references.citation: Am J Gastroenterol. 2002 Oct;97(10):2614-8
references.pmid: 12385448
references.citation: Hepatology. 2002 Nov;36(5 Suppl 1):S47-56
references.pmid: 12407576
references.citation: Aliment Pharmacol Ther. 2007 Aug 1;26(3):359-68
references.pmid: 17635370