Comparison of three algorithms of non-invasive markers of fibrosis in chronic hepatitis C
Version of Record online: 28 OCT 2011
© 2011 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 35, Issue 1, pages 92–104, January 2012
How to Cite
Sebastiani, G., Halfon, P., Castera, L., Mangia, A., Di Marco, V., Pirisi, M., Voiculescu, M., Bourliere, M. and Alberti, A. (2012), Comparison of three algorithms of non-invasive markers of fibrosis in chronic hepatitis C. Alimentary Pharmacology & Therapeutics, 35: 92–104. doi: 10.1111/j.1365-2036.2011.04897.x
- Issue online: 9 DEC 2011
- Version of Record online: 28 OCT 2011
- Publication data Submitted 25 March 2011 First decision 8 May 2011 Resubmitted 4 October 2011 Accepted 4 October 2011 EV Pub Online 28 October 2011
Aliment Pharmacol Ther 2012; 35: 92–104
Background Preliminary data suggest that performance of non-invasive markers for liver fibrosis in hepatitis C may improve when combined. Three algorithms based on the combination of Fibrotest, Forns’ index and AST-to-platelet ratio (APRI) have been proposed: Sequential Algorithm for Fibrosis Evaluation (SAFE biopsy); Fibropaca algorithm; Leroy algorithm.
Aim To compare three algorithms to diagnose significant fibrosis (≥F2 by METAVIR) and cirrhosis (F4).
Methods A total of 1013 HCV monoinfected cases undergoing liver biopsy were consecutively enrolled in seven centres. Fibrotest, APRI and Forns’ index were measured at the time of liver biopsy, considered the reference standard.
Results Overall, performance of combination algorithms was significantly higher than the single non-invasive methods (P < 0.0001). SAFE biopsy and Fibropaca algorithm saved a significantly higher number of liver biopsies than the single methods (P < 0.0001). For ≥F2, Fibropaca algorithm saved more biopsies than SAFE biopsy (51.7% vs. 43.8%, P = 0.0003), but with lower accuracy (87.6% vs. 90.3%, P = 0.05). Regarding F4, the number of saved liver biopsies did not differ between SAFE biopsy and Fibropaca algorithm (79.1% vs. 76.2%, P = 0.12). However, SAFE biopsy showed a lower accuracy when compared with Fibropaca algorithm (91.2% vs. 94%, P = 0.02). As to Leroy algorithm, although it showed a good performance for ≥F2 (93.5% accuracy), it saved less liver biopsies than SAFE biopsy and Fibropaca algorithm (29.2% vs. 43.8% and 51.7% respectively, P < 0.0001).
Conclusions SAFE biopsy and the Fibropaca algorithm have excellent performance for liver fibrosis in hepatitis C, allowing a significant reduction in the need for liver biopsies. They can be useful in clinical practice and for large-scale screening.