Diagnostic accuracy of transient elastography (FibroScan) versus the aspartate transaminase to platelet ratio index in assessing liver fibrosis in chronic hepatitis B: The role in primary care setting

Lesmana, Cosmas Rinaldi Adithya; Salim, Simon; Hasan, Irsan; Sulaiman, Ali; Gani, Rino Alvani; Pakasi, Levina S.; Lesmana, Laurentius M. Adrianto; Krisnuhoni, Ening; Budihusodo, Unggul

doi:10.1136/jclinpath-2011-200044

Cited by 39 publications

(34 citation statements)

References 35 publications

(28 reference statements)

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“…We found that indirect (or mixed) marker panels performed slightly better than the single direct serum markers. Thus, APRI exhibited AUROCs of 0.71 (confidence interval [CI] 0.66–0.75) for diagnosing F ≥ 2 and 0.66 (CI 0.61–0.70) for detecting F4, similar to previous prior studies . The higher performance of APRI found by Zhu et al ., who studied 178 patients with CHB, might be explained by a cohort from which patients with ALT > 2 times ULN were excluded.…”

Section: Discussionsupporting

confidence: 83%

“…For example, the aspartate aminotransferase (AST) to platelet ratio index (APRI) and fibrosis‐4 (FIB‐4) (based on age, AST, alanine aminotransferase [ALT], and platelets) are scores showing good performance to exclude liver cirrhosis . However, they were mostly studied in patients with chronic hepatitis C (CHC), and only few studies addressed their performance in patients with CHB . Notably, to date, all markers showed less accuracy to identify intermediate stages of fibrosis.…”

Section: Introductionmentioning

confidence: 99%

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Transient elastography compared to serum markers to predict liver fibrosis in a cohort of Chinese patients with chronic hepatitis B

Jia

Hou

Ding

et al. 2015

J of Gastro and Hepatol

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Background and Aim: Liver stiffness measurement (LSM) using transient elastography (FibroScan) is a useful tool to assess fibrosis in various chronic liver diseases. However, studies were mainly performed in Western countries and largely focused on chronic hepatitis C (CHC). We therefore carried out a multicenter study to validate the accuracy of LSM in the assessment of liver fibrosis in a large cohort of Chinese patients with chronic hepatitis B (CHB). Methods: We compared LSM results to histological staging and serum fibrosis markers (five direct markers, APRI and FIB-4) using Spearman correlation analysis and area under receiver operating characteristic (ROC) curves (AUROCs). Results: Four hundred sixty-nine patients were enrolled and eligible for statistical analysis. LSM in F0 to F4 was 5.5 ± 1.7, 5.8 ± 2.2, 7.6 ± 3.4, 14.5 ± 10.8, and 22.3 ± 13.6 kPa, respectively (correlation with fibrosis stage r = 0.522, P < 0.001). AUROC for LSM to correctly allocate patients to histological fibrosis stage ≥ F2, ≥ F3, and F4 was 0.82, 0.88, and 0.90, respectively. LSM outperformed serum fibrosis markers for detection of fibrosis F ≥ 2 and F4. Patients with ALT levels 1-5x and > 5x the upper limit of normal values had significantly higher stiffness values than stage-matched patients with normal alanine aminotransferase. Conclusion: Transient elastography is a reliable noninvasive technique to predict significant liver fibrosis in Chinese patients with CHB, being superior to current biomarker panels. However, enhanced inflammatory activity can lead to elevated stiffness values unrelated to histological fibrosis stage.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Transient elastography compared to serum markers to predict liver fibrosis in a cohort of Chinese patients with chronic hepatitis B

Jia

Hou

Ding

et al. 2015

J of Gastro and Hepatol

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“…Sixty‐eight full‐text articles were eligible for evaluation and 29 studies were excluded for the similar studies from one center (n = 8), failure to use biopsy (n = 5), data incomplete (n = 8), or small sample size (n = 8). Finally, 39 studies were selected for evaluation and meta‐analysis . All studies included in this review were from Europe and Asia (Fig.…”

Section: Resultsmentioning

confidence: 99%

Comparison of diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis‐4 index for detecting liver fibrosis in adult patients with chronic hepatitis B virus infection: A systemic review and meta‐analysis

2014

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The aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the four factors (Fibrosis 4 index; FIB-4) are the two most widely studied noninvasive tools for assessing liver fibrosis. Our aims were to systematically review the performance of APRI and FIB-4 in hepatitis B virus (HBV) infection in adult patients and compare their advantages and disadvantages. We examined the diagnostic accuracy of APRI and FIB-4 for significant fibrosis, advanced fibrosis, and cirrhosis based on their sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUROC). Heterogeneity was explored using metaregression. Our systemic review and meta-analysis included 16 articles of APRI only, 21 articles of APRI and FIB-4 and two articles of FIB-4 for detecting different levels of liver fibrosis. With an APRI threshold of 0.5, 1.0, and 1.5, the sensitivity and specificity values were 70.0% and 60.0%, 50.0% and 83.0%, and 36.9% and 92.5% for significant fibrosis, advanced fibrosis, and cirrhosis, respectively. With an FIB-4 threshold of 1.45 and 3.25, the sensitivity and specificity values were 65.4% and 73.6% and 16.2% and 95.2% for significant fibrosis. The summary AUROC values using APRI and FIB-4 for the diagnosis of significant fibrosis, advanced fibrosis, and cirrhosis were 0.7407 (95% confidence interval [CI]: 0.7033-0.7781) and 0.7844 (95% CI: 0.7450-0.8238; (Z 5 1.59, P 5 0.06), 0.7347 (95% CI: 0.6790-0.7904) and 0.8165 (95% CI: 0.7707-0.8623; Z 5 2.01, P 5 0.02), and 0.7268 (95% CI: 0.6578-0.7958) and 0.8448 (95% CI: 0.7742-0.9154; (Z 5 2.34, P 5 0.01), respectively. Conclusions: Our meta-analysis suggests that APRI and FIB-4 can identify hepatitis B-related fibrosis with a moderate sensitivity and accuracy. (HEPATOLOGY 2015;61:292-302)

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“…The full texts of 165 potentially eligible reports were obtained for further assessment. Of those, 19 papers were included in the review following full-text screening [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41].…”

Section: Search Resultsmentioning

confidence: 99%

Performance of transient elastography assessing fibrosis of single hepatitis B virus infection: a systematic review and meta-analysis of a diagnostic test

Song

et al. 2015

Hepatol Int

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Diagnostic accuracy of transient elastography (FibroScan) versus the aspartate transaminase to platelet ratio index in assessing liver fibrosis in chronic hepatitis B: The role in primary care setting

Abstract: APRI is a useful marker to screen liver fibrosis in the primary care setting when TE is not available.

Cited by 39 publications

References 35 publications

Transient elastography compared to serum markers to predict liver fibrosis in a cohort of Chinese patients with chronic hepatitis B

Transient elastography compared to serum markers to predict liver fibrosis in a cohort of Chinese patients with chronic hepatitis B

Comparison of diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis‐4 index for detecting liver fibrosis in adult patients with chronic hepatitis B virus infection: A systemic review and meta‐analysis

Performance of transient elastography assessing fibrosis of single hepatitis B virus infection: a systematic review and meta-analysis of a diagnostic test

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