Comparison of eight diagnostic algorithms for liver fibrosis in hepatitis C: new algorithms are more precise and entirely noninvasive

Authors

  • Jérôme Boursier,

    Corresponding author
    1. Department of Hepatogastroenterology, University Hospital, Angers, France
    2. HIFIH Laboratory, UPRES 3859, Institut Fédératif de Recherche (IFR) 132, University of Angers, Pôle de Recherche et d'Enseignement Supérieur Université Nantes Angers Le Mans (PRES UNAM), France
    • Service d'Hépato-Gastroentérologie, CHU, 49933 Angers Cedex 09, France
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    • fax: (33) 2 41 35 41 19

  • Victor de Ledinghen,

    1. Department of Hepatogastroenterology, Haut-Lévêque University Hospital, Pessac, France
    2. Institut National de la Santé et de la Recherche Médicale (INSERM) U889, Victor Segalen University, Bordeaux, France
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  • Jean-Pierre Zarski,

    1. Department of Liver-Gastroenterology, University Hospital, Grenoble, France
    2. Institut National de la Santé et de la Recherche Médicale (INSERM)/UJF U823, IAPC, IAB, Grenoble, France
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  • Isabelle Fouchard-Hubert,

    1. Department of Hepatogastroenterology, University Hospital, Angers, France
    2. HIFIH Laboratory, UPRES 3859, Institut Fédératif de Recherche (IFR) 132, University of Angers, Pôle de Recherche et d'Enseignement Supérieur Université Nantes Angers Le Mans (PRES UNAM), France
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  • Yves Gallois,

    1. HIFIH Laboratory, UPRES 3859, Institut Fédératif de Recherche (IFR) 132, University of Angers, Pôle de Recherche et d'Enseignement Supérieur Université Nantes Angers Le Mans (PRES UNAM), France
    2. Department of Biochemistry, University Hospital, Angers, France
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  • Frédéric Oberti,

    1. Department of Hepatogastroenterology, University Hospital, Angers, France
    2. HIFIH Laboratory, UPRES 3859, Institut Fédératif de Recherche (IFR) 132, University of Angers, Pôle de Recherche et d'Enseignement Supérieur Université Nantes Angers Le Mans (PRES UNAM), France
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  • Paul Calès,

    1. Department of Hepatogastroenterology, University Hospital, Angers, France
    2. HIFIH Laboratory, UPRES 3859, Institut Fédératif de Recherche (IFR) 132, University of Angers, Pôle de Recherche et d'Enseignement Supérieur Université Nantes Angers Le Mans (PRES UNAM), France
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  • multicentric groups from SNIFF 32, VINDIAG 7, and ANRS/HC/EP23 FIBROSTAR studies

    1. Department of Hepatogastroenterology, University Hospital, Angers, France
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  • Potential conflict of interest: P.C., I.F.H., and F.O. have stock ownership in BioLiveScale Inc., which has a license for FibroMeter from the University of Angers.

  • Supported by the Program Hospitalier de Recherche Clinique (PHRC) of the French Department of Health in 1994 and 2002 for SNIFF 32 and the Agence National de Recherche sur le Sida et les Hépatites (ANRS) for FIBROSTAR HC/EP23.

Abstract

The sequential algorithm for fibrosis evaluation (SAFE) and the Bordeaux algorithm (BA), which cross-check FibroTest with the aspartate aminotransferase-to-platelet ratio index (APRI) or FibroScan, are very accurate but provide only a binary diagnosis of significant fibrosis (SAFE or BA for Metavir F ≥ 2) or cirrhosis (SAFE or BA for F4). Therefore, in clinical practice, physicians have to apply the algorithm for F ≥ 2, and then, when needed, the algorithm for F4 (“successive algorithms”). We aimed to evaluate successive SAFE, successive BA, and a new, noninvasive, detailed classification of fibrosis. The study included 1785 patients with chronic hepatitis C, liver biopsy, blood fibrosis tests, and FibroScan (the latter in 729 patients). The most accurate synchronous combination of FibroScan with a blood test (FibroMeter) provided a new detailed (six classes) classification (FM+FS). Successive SAFE had a significantly (P < 10−3) lower diagnostic accuracy (87.3%) than individual SAFE for F ≥ 2 (94.6%) or SAFE for F4 (89.5%), and required significantly more biopsies (70.8% versus 64.0% or 6.4%, respectively, P < 10−3). Similarly, successive BA had significantly (P ≤ 10−3) lower diagnostic accuracy (84.7%) than individual BA for F ≥ 2 (88.3%) or BA for F4 (94.2%), and required significantly more biopsies (49.8% versus 34.6% or 24.6%, respectively, P < 10−3). The diagnostic accuracy of the FM+FS classification (86.7%) was not significantly different from those of successive SAFE or BA. However, this new classification required no biopsy. Conclusion: SAFE and BA for significant fibrosis or cirrhosis are very accurate. However, their successive use induces a significant decrease in diagnostic accuracy and a significant increase in required liver biopsy. A new fibrosis classification that synchronously combines two fibrosis tests was as accurate as successive SAFE or BA, while providing an entirely noninvasive (0% liver biopsy) and more precise (six versus two or three fibrosis classes) fibrosis diagnosis. (HEPATOLOGY 2012;55:58–67)

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