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Fibrotest or Fibroscan for evaluation of liver fibrosis in haemophilia patients infected with hepatitis C


Yaakov Maor, MD, Department of Gastroenterology and Hepatology, Sheba Medical Center, 52621 Tel-Hashomer, Israel.
Tel.: +972 3 530 2906; fax: +972 3 530 3160;


Summary.  Non-invasive modalities to estimate fibrosis stage are desirable in hepatitis C-infected haemophilia patients. Previous studies found a high rate of significant fibrosis both by Fibrotest (FT) and Fibroscan (FS) in these patients. To estimate liver fibrosis and to assess the concordance between FT and FS in hepatitis C-infected haemophilia patients. FT and FS were performed at different laboratories and were unaware of the results of the alternative test. Three successive liver stiffness measurements (LSM) were performed at different sites on the liver. Two-validated algorithms were used to improve evaluation of fibrosis by non-invasive methods. Fifty-seven hepatitis C-infected haemophilia patients were evaluated by FT and FS. Acquisition of LSMs was not feasible in two patients: obesity – one, surgical scars – one. Fibrosis stage ≥F2, ≥F3 or =F4 were estimated in about a half, about a third and in 15–20% of the evaluated patients by FS and FT respectively. The corresponding concordance rates and κ score for fibrosis stage ≥F2, ≥F3 or =F4 between FT and FS were 62%, 69%, 85% and 0.24, 0.32, 0.44 respectively. Using the two aforementioned algorithms, additional 14 patients could be reliably estimated for fibrosis stage ≥F2. High proportion hepatitis C-infected haemophilia patients were estimated with significant or advanced stages of liver fibrosis using both tests. Nevertheless, the agreement between modalities was only fair and improved with more advanced stages of fibrosis. Practical algorithms for the accuracy of FT and FS may improve reliable evaluation of fibrosis in this population.