title: A stepwise algorithm using an at-a-glance first-line test for the non-invasive diagnosis of advanced liver fibrosis and cirrhosis.
abstract: Chronic liver diseases (CLD) are common, and are therefore mainly managed by non-hepatologists. These physicians lack access to the best non-invasive tests of liver fibrosis, and consequently cannot accurately determine the disease severity. Referral to a hepatologist is then needed. We aimed to implement an algorithm, comprising a new first-line test usable by all physicians, for the detection of advanced liver fibrosis in all CLD patients.
  
  
  
  Diagnostic study: 3754 CLD patients with liver biopsy were 2:1 randomized into derivation and validation sets. Prognostic study: longitudinal follow-up of 1275 CLD patients with baseline fibrosis tests.
  
  
  
  Diagnostic study: the easy liver fibrosis test (eLIFT), an "at-a-glance" sum of points attributed to age, gender, gamma-glutamyl transferase, aspartate aminotransferase (AST), platelets and prothrombin time, was developed for the diagnosis of advanced fibrosis. In the validation set, eLIFT and fibrosis-4 (FIB4) had the same sensitivity (78.0% vs. 76.6%, p=0.470) but eLIFT gave fewer false positive results, especially in patients ≥60years old (53.8% vs. 82.0%, p<0.001), and was thus more suitable as screening test. FibroMeter with vibration controlled transient elastography (VCTE) was the most accurate among the eight fibrosis tests evaluated. The sensitivity of the eLIFT-FMVCTEalgorithm (first-line eLIFT, second-line FibroMeterVCTE) was 76.1% for advanced fibrosis and 92.1% for cirrhosis. Prognostic study: patients diagnosed as having "no/mild fibrosis" by the algorithm had excellent liver-related prognosis with thus no need for referral to a hepatologist.
  
  
  
  The eLIFT-FMVCTEalgorithm extends the detection of advanced liver fibrosis to all CLD patients and reduces unnecessary referrals of patients without significant CLD to hepatologists.
  
  
  
  Blood fibrosis tests and transient elastography accurately diagnose advanced liver fibrosis in the large population of patients having chronic liver disease, but these non-invasive tests are only currently available in specialized centers. We have developed an algorithm including the easy liver fibrosis test (eLIFT), a new simple and widely available blood test. It is used as a first-line procedure that selects at-risk patients who need further evaluation with the FibroMeterVCTE, an accurate fibrosis test combining blood markers and transient elastography result. This new algorithm, called the eLIFT-FMVCTE, accurately identifies the patients with advanced chronic liver disease who need referral to a specialist, and those with no or mild liver lesions who can remain under the care of their usual physician.
  
  
  
  No registration (analysis of pooled data from previously published diagnostic studies).
authors.affiliation: Hepatology Department, University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Bretagne Loire University, Angers, France. Electronic address: JeBoursier@chu-angers.fr.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Boursier
authors.affiliation: Hepatology Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France; INSERM U1053, Bordeaux University, Bordeaux, France.
authors.forename: Victor
authors.initials: V
authors.lastname: de Ledinghen
authors.affiliation: Hepato-Gastroenterology Clinic, University Hospital, Grenoble, France; INSERM U823, Grenoble Alpes University, Grenoble, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Leroy
authors.affiliation: Digestive Center, University Hospital of Nice, Nice, France; INSERM U1065, Sophia-Antipolis Nice University, Nice, France.
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Anty
authors.affiliation: Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium; Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Edegem, Belgium.
authors.forename: Sven
authors.initials: S
authors.lastname: Francque
authors.affiliation: Internal Medicine Department, Cochin Hospital, APHP, Paris, France; Descartes University, Sorbonne Paris Cité, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Salmon
authors.affiliation: Hepatology Department, University Hospital, Angers, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Lannes
authors.affiliation: HIFIH Laboratory, UPRES 3859, SFR 4208, Bretagne Loire University, Angers, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Bertrais
authors.affiliation: Hepatology Department, University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Bretagne Loire University, Angers, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Oberti
authors.affiliation: Hepatology Department, University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Bretagne Loire University, Angers, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Fouchard-Hubert
authors.affiliation: Hepatology Department, University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Bretagne Loire University, Angers, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Calès
mesh_terms: D000328:Adult; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003430:Cross-Sectional Studies; D054459:Elasticity Imaging Techniques; D005260:Female; D005500:Follow-Up Studies; D006403:Hematologic Tests; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis
chemical_list: D015415:Biomarkers
keywords: Algorithms; Cirrhosis; Liver fibrosis; Liver function tests; Non-invasive tests