Comparison of test performance profile for blood tests of liver fibrosis in chronic hepatitis C

Halfon, Philippe; Bacq, Yannick; Muret, A. De; Pénaranda, Guillaume; Bourlière, Marc; Ouzan, Denis; Tran, Albert; Botta, D.; Renou, Christophe; Bréchot, M.C.; Degott, Claude; Paradis, Valérie

doi:10.1016/j.jhep.2006.09.020

Cited by 119 publications

(79 citation statements)

References 21 publications

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“…Thirty-three studies examined the APRI in patients with chronic hepatitis C. Ultimately, 11 studies were excluded for duplication of data (n ϭ 1), 38 insufficient data (n ϭ 5), 11,[39][40][41][42] small sample size (n ϭ 2), 43,44 or failure to use biopsy as the reference test (n ϭ 3). [45][46][47] Thus, our final data set for the meta-analysis included 22 studies (Table 1).…”

Section: Search Resultsmentioning

confidence: 99%

“…Although we did not address this directly, the AUC of 0.76 that we observed for significant fibrosis is similar to that of the FibroTest in a meta-analysis by Poynard and colleagues (0.79; 95% CI 0.77-0.82). 71 Similarly, in a multicenter comparative study of fibrosis markers, 38 the AUC for significant fibrosis of the 40 This largely insignificant difference between the APRI, which is inexpensive and available for all HCV-infected patients, versus other more costly and specialized fibrosis measures underscores 2 important points. First, before the latter tools are widely used, their incremental cost-effectiveness, or the tradeoff between increased accuracy (if there is any) and cost, should be demonstrated.…”

Section: Discussionmentioning

confidence: 99%

“…Biopsy length, specifically, was not significant in the meta-regression analyses, although this has been reported to affect the accuracy of some fibrosis markers. 38,73,74 Because most of the studies did not exclude suboptimal biopsy specimens (or did not report biopsy characteristics), we would encourage future investigators to be rigorous in their assessment of the quality of liver biopsies, ensuring adequate length and portal tract number. 5 Although these negative findings may reflect a type II error, we hypothesize that they likely relate to "unquantifiable" differences between studies such as the quality of histopathologists, heterogeneous patient populations, and different assays and reference ranges for AST (reported in only 1 of the studies).…”

Section: Discussionmentioning

confidence: 99%

“…Regarding histopathological classification systems, 11 studies used Ishak, 4 used METAVIR, 4 used Scheuer, and 3 used Batts and Ludwig. Nineteen studies included HCVmonoinfected patients (n ϭ 3,822), 17,20,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] and 4 included HIV/HCV-co-infected patients (n ϭ 444). [48][49][50][51] Biopsy quality was considered acceptable in only 4 of the 22 studies.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis C–related fibrosis: A systematic review

2007

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The development of noninvasive markers of liver fibrosis is a clinical and research priority. The aspartate aminotransferase-to-platelet ratio index (APRI) is a promising tool with limited expense and widespread availability. Our objective was to systematically review the performance of the APRI in hepatitis C virus (HCV)-infected patients. Random effects meta-analyses and areas under summary receiver operating characteristic curves (AUC) were examined to characterize APRI accuracy for significant fibrosis (stages 2-4) and cirrhosis. In 22 studies (n ‫؍‬ 4,266), the summary AUCs of the APRI for significant fibrosis and cirrhosis were 0.76 [95% confidence interval (CI), 0.74-0.79] and 0.82 (95%CI, 0.79-0.86), respectively. For significant fibrosis, an APRI threshold of 0.5 was 81% sensitive and 50% specific. At a 40% prevalence of significant fibrosis, this threshold had a negative predictive value (NPV) of 80%, but could reduce the necessity of liver biopsy by only 35%. For cirrhosis, a threshold of 1.0 was 76% sensitive and 71% specific. At a 15% cirrhosis prevalence, the NPV of this threshold was 91%. Higher APRI thresholds had suboptimal positive predictive values except in settings with a high prevalence of cirrhosis. APRI accuracy was not affected by the prevalence of advanced fibrosis, or study and biopsy quality. However, the accuracy for cirrhosis was greater in studies including human immunodeficiency virus (HIV)/HCV-co-infected patients. Conclusion: The major strength of the APRI is the exclusion of significant HCV-related fibrosis. Future studies of novel markers should demonstrate improved accuracy and cost-effectiveness compared with this economical and widely available index. (HEPATOLOGY 2007;46:912-921.)

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Section: Search Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis C–related fibrosis: A systematic review

2007

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“…Our results were similar to previous direct comparisons in patients with hepatitis C, in which no significant differences between these patented biomarkers were found. 33,34 Indirect comparisons between sensitivities, specificities, AUROC and predictive values are hazardous due to variability factors, the two most important being the prevalences of stages defining advanced and nonadvanced fibrosis and the biopsy length (28,29).…”

Section: Discussionmentioning

confidence: 99%