Meta-Analyses of FibroTest Diagnostic Value in Chronic Liver Disease

Thierry Poynard; Rachel Morra; Philippe Halfon; Laurent Castera; Vlad Ratziu; Françoise Imbert-Bismut; Sylvie Naveau; Dominique Thabut; Didier Lebrec; Fabien Zoulim; Marc Bourliere; Patrice Cacoub; Djamila Messous; Mona Munteanu; Victor de Ledinghen

Disclosures

BMC Gastroenterol 

In This Article

Abstract and Background

Abstract

Background: FibroTest (FT) is a biomarker of liver fibrosis initially validated in patients with chronic hepatitis C (CHC).
The aim was to test two hypotheses, one, that the FT diagnostic value was similar in the three other frequent fibrotic diseases: chronic hepatitis B (CHB), alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD); and the other, that the FT diagnostic value was similar for intermediate and extreme fibrosis stages.
Methods: The main end points were the FT area under the ROC curves (AUROCs) for the diagnosis of bridging fibrosis (F2F3F4 vs. F0F1), standardized for the spectrum of fibrosis stages, and the comparison of FT AUROCs between adjacent stages. Two meta-analyses were performed: one combining all the published studies (random model), and one of an integrated data base combining individual data. Sensitivity analysis integrated the independency of authors, lenght of biopsy, prospective design, respect of procedures, comorbidities, and duration between biopsy and serum sampling.
Results: A total of 30 studies were included which pooled 6,378 subjects with both FT and biopsy (3,501 HCV, 1,457 HBV, 267 NAFLD, 429 ALD, and 724 mixed). Individual data were analyzed in 3,282 patients. The mean standardized AUROC was 0.84 (95% CI, 0.83–0.86), without differences between causes of liver disease: HCV 0.85 (0.82–0.87), HBV 0.80 (0.77–0.84), NAFLD 0.84 (0.76–0.92), ALD 0.86 (0.80–0.92), mixed 0.85 (0.80–0.93). The AUROC for the diagnosis of the intermediate adjacent stages F2 vs. F1 (0.66; 0.63–0.68, n = 2,055) did not differ from that of the extreme stages F3 vs. F4 (0.69; 0.65–0.72, n = 817) or F1 vs. F0 (0.62; 0.59–0.65, n = 1788).
Conclusion: FibroTest is an effective alternative to biopsy in patients with chronic hepatitis C and B, ALD and NAFLD. The FT diagnostic value is similar for the diagnosis of intermediate and extreme fibrosis stages.

Background

Fibrotest (FT) is a biomarker of liver fibrosis which was initially validated in patients with chronic hepatitis C (HCV)[1] and then in the three other common fibrotic liver diseases:[2] chronic hepatitis B (HBV),[3,4] alcoholic liver disease (ALD)[5,6,7] and non-alcoholic fatty liver disease (NAFLD).[8]

FT is widely used as a non invasive alternative to liver biopsy, with 190,000 tests ordered between September 2002 and April 2007 (Biopredictive data on file, Jean Marie Castille, personal communication); however, two main critiques are often made by experts: 1) FT has been mainly studied in chronic hepatitis C, and 2) the FT diagnostic value is lower for intermediate fibrosis stages (bridging vs. non bridging fibrosis) than for extreme stages (no fibrosis or cirrhosis).[10] In this latter critique, which is also true for liver biopsy, there is a risk of confusion between adjacent stages and intermediate stages or an absence of taking into account the prevalence of fibrosis stages defining advanced and non-advanced fibrosis.[11,12]

The aim of this meta-analysis was to test two hypotheses, first, that the FT diagnostic value was similar in patients with HCV and in patients with the three other frequent fibrotic diseases; and second, that the FT diagnostic value was similar for intermediate and extreme stages.

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