Development of a non-invasive algorithm with transient elastography (Fibroscan) and serum test formula for advanced liver fibrosis in chronic hepatitis B


Dr H. L. Y. Chan, Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong, China.


Aliment Pharmacol Ther31, 1095–1103


Background  Non-invasive assessments of liver fibrosis in chronic hepatitis B were well established.

Aim  To develop a combined algorithm of liver stiffness measurement (LSM) and serum test formula to predict advanced liver fibrosis in chronic hepatitis B.

Methods  We reported an alanine aminotransferase (AST)-based LSM algorithm for liver fibrosis in 156 chronic hepatitis B patients, which formed the training cohort to evaluate the performance of APRI (AST-to-platelet-ratio-index), Forns index, FIB-4 and Fibroindex against liver histology. The best combined LSM-serum formula algorithm would be validated in another cohort of 82 chronic hepatitis B patients.

Results  In the training cohort, LSM has the best performance of diagnosing advanced (≥F3) fibrosis [area under the receiver operating characteristics curve (AUROC) 0.88, 95% confidence interval (CI) 0.85–0.91], while Forns index has the best performance among the various serum test formulae (AUROC 0.70, 95% CI 0.62–0.78). In the combined algorithm, low LSM or low Forns index could be used to exclude advanced fibrosis as both of them had high sensitivity (>90%). To confirm advanced fibrosis, agreement between high LSM and high Forns index could improve the specificity (from 99% to 100% and from 87% to 98% in the training and validation cohorts respectively).

Conclusion  A combined LSM–Forns algorithm can improve the accuracy to predict advanced liver fibrosis in chronic hepatitis B.