Optimized stepwise combination algorithms of non‐invasive liver fibrosis scores including Hepascore in hepatitis C virus patients

Abstract

Summary Background Non‐invasive liver fibrosis scores such as Hepascore (HS) have been proposed as an alternative to liver biopsy in hepatitis C virus (HCV)‐infected patients. Aim To validate HS as an alternative to liver biopsy and Fibrotest (FT) and propose five optimized combination algorithms to improve diagnostic accuracy. Methods The cohort included 467 patients with HCV. There were 274/467 (59%) men, and mean age was 47 ± 12 years. Results Hepascore area under ROC curves (AUC) for ≥F2, F3F4 and F4 diagnosis were 0.82, 0.84 and 0.90 respectively, in the same range as FT. HS and FT were concordant in 387/467 (82%) for fibrosis staging. Among these patients, 342/387 (88%) were concordant with liver biopsy. AUCs of aspartate aminotransferase (AST) to Platelets Ratio Index (APRI) and Forns for ≥F2 were 0.76 and 0.73 (0.65–0.79) respectively. The algorithm combining APRI and HS had the highest rate of avoided liver biopsies (45%) with a high diagnostic accuracy (91%). Conclusions Hepascore is an accurate non‐invasive marker for ≥F2 and F4 diagnosis in HCV patients. In a pragmatic approach, a stepwise optimized algorithm combining APRI and FT or HS considerably increases diagnostic accuracy and avoided liver biopsies.

Non-invasive assessment of liver fibrosis in chronic hepatitis C

“…These results have been confirmed in a large-scale, multicenter international validation study of more than 2,000 patients with chronic hepatitis C [110]. Other groups have proposed alternative algorithms combining FibroTest Ò and APRI [53] either with Forns index (Fibropaca) [111] or Hepascore [112].…”

Epidemiology, Responses, and Way Forward

“…It reportedly has a general specificity of approximately 80% for identifying both significant and advanced fibrosis. 76,79,80 The elastography, an ultrasound-based method is already being used in some hospitals in Vietnam. The transient elastography, also known as FibroScan, uses the speed of propagation of waves created by the transducer to estimate the stiffness of the liver tissue.…”

“…[74][75][76][77][78][79][80][81][82][83] One of the most investigated scales is the Hepascore using a combination of commonly available laboratory markers. It reportedly has a general specificity of approximately 80% for identifying both significant and advanced fibrosis.…”

Options of non-invasive assessment of liver fibrosis based on the clinical data

“…A Fibrotest és APRI alkalmazásával létrehozott Leroy's algoritmus pozitív és negatív prediktív értéke körülbelül 95% [35], de nem volt reprodukálható [14]. A Hepascore és az APRI új szekvenciális kombinációjával >94% feletti pontosság volt elérhető [36].…”