title: Systematic review with meta-analysis: direct comparisons of biomarkers for the diagnosis of fibrosis in chronic hepatitis C and B.
abstract: BACKGROUND
  Blood tests and transient elastography (TE), proposed as alternatives to biopsy for identifying advanced fibrosis (METAVIR-stage-F2 or greater) or cirrhosis, have never been compared using an intention to diagnose approach, with direct comparisons only, and Bayesian approach.
  
  
  OBJECTIVE
  To permit more appropriate comparisons.
  
  
  METHODS
  From an overview of articles (2002-2014), we selected studies that directly compared the diagnostic accuracy of FibroTest, aspartate aminotransferase-platelet ratio index (APRI), FIB4 or TE, with biopsy as a reference, in patients with chronic hepatitis C (CHC) or B (CHB). Investigators abstracted and checked study details and quality by using pre-defined criteria. Bayesian method in intention to diagnose was the primary outcome.
  
  
  RESULTS
  Of 1321 articles identified, 71 studies including 77 groups according to aetiology (All-CB) were eligible: 37 Only-C, 28 Only-B and 12 Mixed-C-B. There were 185 direct comparisons between the area under the ROC curves (AUROCs), 99 for the diagnosis of advanced fibrosis and 86 for cirrhosis. In All-CB, Bayesian analyses revealed significant AUROCs differences in identifying advanced fibrosis in favour of FibroTest vs. TE [credibility interval: 0.06(0.02-0.09)], FibroTest vs. APRI [0.05 (0.03-0.07)] and for identifying cirrhosis TE vs. APRI [0.07 (0.02-0.13)] and FIB4 vs. APRI [0.04(0.02-0.05)]. No differences were observed between TE and FibroTest, for identifying cirrhosis in All-CB, and in sub-groups (Only-C, Only-B, Mixed-CB) for both cirrhosis and fibrosis.
  
  
  CONCLUSIONS
  In CHC and CHB, APRI had lower performances than FIB-4, TE and FibroTest. TE had lower performance than FibroTest for identifying advanced fibrosis in All-CB, without significant difference for identifying cirrhosis in all groups.
authors.affiliation: BioPredictive, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Houot
authors.affiliation: BioPredictive, Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Ngo
authors.affiliation: BioPredictive, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Munteanu
authors.affiliation: Capionis, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Marque
authors.affiliation: Hepatology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France.|INSERM & Université Pierre et Marie Curie - Univ Paris 06, UMR_S 938, Centre de Recherche Saint-Antoine & Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Poynard
mesh_terms: D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood; D001499:Bayes Theorem; D015415:Biomarkers; D001706:Biopsy; D054459:Elasticity Imaging Techniques; D019694:Hepatitis B, Chronic / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D019698:Hepatitis C, Chronic / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000000981:diagnostic imaging / Q000473:pathology*
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases