title: Concordance of non-invasive mechanical and serum tests for liver fibrosis evaluation in chronic hepatitis C.
abstract: OBJECTIVE
  To determine the sensitivity and specificity of liver stiffness measurement (LSM) and serum markers (SM) for liver fibrosis evaluation in chronic hepatitis C.
  
  
  METHODS
  Between 2012 and 2014, 81 consecutive hepatitis C virus (HCV) patients had METAVIR score from liver biopsy compared with concurrent results from LSM [transient elastography (TE) [FibroScan®/ARFI technology (Virtual Touch®)] and SM [FIB-4/aspartate aminotransferase-to-platelet ratio index (APRI)]. The diagnostic performance of these tests was assessed using receiver operating characteristic curves. The optimal cut-off levels of each test were chosen to define fibrosis stages F ≥ 2, F ≥ 3 and F = 4. The Kappa index set the concordance analysis.
  
  
  RESULTS
  Fifty point six percent were female and the median age was 51 years (30-78). Fifty-six patients (70%) were treatment-naïve. The optimal cut-off values for predicting F ≥ 2 stage fibrosis assessed by TE were 6.6 kPa, for acoustic radiation force impulse (ARFI) 1.22 m/s, for APRI 0.75 and for FIB-4 1.47. For F ≥ 3 TE was 8.9 kPa, ARFI was 1.48 m/s, APRI was 0.75, and FIB-4 was 2. For F = 4, TE was 12.2 kPa, ARFI was 1.77 m/s, APRI was 1.46, and FIB-4 was 3.91. The APRI could not distinguish between F2 and F3,P= 0.92. The negative predictive value for F = 4 for TE and ARFI was 100%. Kappa index values for F ≥ 3 METAVIR score for TE, ARFI and FIB-4 were 0.687, 0.606 and 0.654, respectively. This demonstrates strong concordance between all three screening methods, and moderate to strong concordance between them and APRI (Kappa index = 0.507).
  
  
  CONCLUSIONS
  Given the costs and accessibility of LSM methods, and the similarity with the outcomes of SM, we suggest that FIB-4 as well as TE and ARFI may be useful indicators of the degree of liver fibrosis. This is of particular importance to developing countries.
authors.affiliation: Denise C Paranaguá-Vezozzo, Adriana Andrade, Daniel F C Mazo, Vinicius Nunes, Ana L Guedes, Taisa G Ragazzo, Renata Moutinho, Lucas S Nacif, Suzane K Ono, Flair J Carrilho, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-900, Brazil.
authors.forename: Denise C
authors.initials: DC
authors.lastname: Paranaguá-Vezozzo
authors.affiliation: Denise C Paranaguá-Vezozzo, Adriana Andrade, Daniel F C Mazo, Vinicius Nunes, Ana L Guedes, Taisa G Ragazzo, Renata Moutinho, Lucas S Nacif, Suzane K Ono, Flair J Carrilho, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-900, Brazil.
authors.forename: Adriana
authors.initials: A
authors.lastname: Andrade
authors.affiliation: Denise C Paranaguá-Vezozzo, Adriana Andrade, Daniel F C Mazo, Vinicius Nunes, Ana L Guedes, Taisa G Ragazzo, Renata Moutinho, Lucas S Nacif, Suzane K Ono, Flair J Carrilho, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-900, Brazil.
authors.forename: Daniel F C
authors.initials: DF
authors.lastname: Mazo
authors.affiliation: Denise C Paranaguá-Vezozzo, Adriana Andrade, Daniel F C Mazo, Vinicius Nunes, Ana L Guedes, Taisa G Ragazzo, Renata Moutinho, Lucas S Nacif, Suzane K Ono, Flair J Carrilho, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-900, Brazil.
authors.forename: Vinicius
authors.initials: V
authors.lastname: Nunes
authors.affiliation: Denise C Paranaguá-Vezozzo, Adriana Andrade, Daniel F C Mazo, Vinicius Nunes, Ana L Guedes, Taisa G Ragazzo, Renata Moutinho, Lucas S Nacif, Suzane K Ono, Flair J Carrilho, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-900, Brazil.
authors.forename: Ana L
authors.initials: AL
authors.lastname: Guedes
authors.affiliation: Denise C Paranaguá-Vezozzo, Adriana Andrade, Daniel F C Mazo, Vinicius Nunes, Ana L Guedes, Taisa G Ragazzo, Renata Moutinho, Lucas S Nacif, Suzane K Ono, Flair J Carrilho, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-900, Brazil.
authors.forename: Taisa G
authors.initials: TG
authors.lastname: Ragazzo
authors.affiliation: Denise C Paranaguá-Vezozzo, Adriana Andrade, Daniel F C Mazo, Vinicius Nunes, Ana L Guedes, Taisa G Ragazzo, Renata Moutinho, Lucas S Nacif, Suzane K Ono, Flair J Carrilho, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-900, Brazil.
authors.forename: Renata
authors.initials: R
authors.lastname: Moutinho
authors.affiliation: Denise C Paranaguá-Vezozzo, Adriana Andrade, Daniel F C Mazo, Vinicius Nunes, Ana L Guedes, Taisa G Ragazzo, Renata Moutinho, Lucas S Nacif, Suzane K Ono, Flair J Carrilho, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-900, Brazil.
authors.forename: Lucas S
authors.initials: LS
authors.lastname: Nacif
authors.affiliation: Denise C Paranaguá-Vezozzo, Adriana Andrade, Daniel F C Mazo, Vinicius Nunes, Ana L Guedes, Taisa G Ragazzo, Renata Moutinho, Lucas S Nacif, Suzane K Ono, Flair J Carrilho, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-900, Brazil.
authors.forename: Suzane K
authors.initials: SK
authors.lastname: Ono
authors.affiliation: Denise C Paranaguá-Vezozzo, Adriana Andrade, Daniel F C Mazo, Vinicius Nunes, Ana L Guedes, Taisa G Ragazzo, Renata Moutinho, Lucas S Nacif, Suzane K Ono, Flair J Carrilho, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-900, Brazil.
authors.forename: Venâncio A F
authors.initials: VA
authors.lastname: Alves
authors.affiliation: Denise C Paranaguá-Vezozzo, Adriana Andrade, Daniel F C Mazo, Vinicius Nunes, Ana L Guedes, Taisa G Ragazzo, Renata Moutinho, Lucas S Nacif, Suzane K Ono, Flair J Carrilho, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-900, Brazil.
authors.forename: Flair J
authors.initials: FJ
authors.lastname: Carrilho
keywords: Elastography; Hepatitis C virus; Liver biopsy; Liver stiffness; Serum markers