Page 9 - NON-INVASIVE TESTS FOR EVALUATION OF LIVER DISEASE SEVERITY AND PROGNOSIS
P. 9
Clinical Practice Guidelines Recommendations
and 284 HBV patients), which prospectively compared the • When compared in HCV patients, the different
widely used patented tests (FibroTestÒ, FibroMeterÒ, and patented tests have similar levels of performance in
HepaScoreÒ) with the non-patented test (APRI), the AUROC val- diagnosing significant fibrosis and cirrhosis (A1)
ues for significant fibrosis ranged from 0.72 to 0.78 with no sig-
nificant differences among scores [124]. In patients with • Although non-patented tests might have lower
cirrhosis, the AUROC values were higher for all tests, ranging diagnostic accuracy than patented tests, they are not
from 0.77 to 0.86, with no significant differences among the associated with additional costs, are easy to calculate,
tests. Although non-patented tests such as the Forns index, and are widely available (A2)
FIB-4, and APRI were not as accurate as patented tests [125],
there are no additional costs, they are easy to calculate, and
are widely available.
Table 5. Diagnostic performance of TE for significant fibrosis (F P2) and cirrhosis (F4) in patients with viral hepatitis B and C.
Authors Etiologies Year Patient F≥2 F4 Cut-offs AUROC Se Sp CC
(n) (%) (%)
(kPa) (%) (%) (%)
Castera et al. [126] HCV 2005 183 74 7.1 0.83 67 89 73
25 12.5 0.95 87 91 90
Ziol et al. [127] HCV 2005 251 65 8.6 0.79 56 91 68
19 14.6 0.87 86 96 94
Arena et al. [86] HCV 2008 150 56 7.8 0.91 83 82 83
19 14.8 0.98 94 92 92
Lupsor et al. [128] HCV 2008 324 65 7.4 0.86 76 84 79
21 11.9 0.94 87 91 90
Wang et al. [134] HCV 2009 214 42 9.5 0.82 70 83 n.a.
19 12 0.93 79 85 n.a.
Degos et al. [124] HCV 2010 913 62 5.2 0.75 90 32 57
14 12.9 0.90 72 89 87
Zarski et al. [125] HCV 2012 382 47 5.2 0.82 97 35 64
14 12.9 0.93 77 90 88
Coco et al. [69] HBV (HCV) 2007 228 62 8.3 0.93 85 91 87
50* 14.0 0.96 78 98 88
Oliveri et al. [130] HBV 2008 188 26 7.5 0.97 94 88 90
20* 11.8 0.97 86 96 94
Marcellin et al. [131] HBV 2009 173 50 7.2 0.81 70 83 76
8 11.0 0.93 93 87 94
Chan et al. [132] HBV 2009 161 25 12-13.4a 0.93 98 75 85
Kim et al. [133] HBV 2009 91 43 9.7 0.80 82 59 62
Wang et al. [134] HBV 2009 88 42 8.0 0.86 80 77 n.a.
19 10.0 0.89 85 88 n.a.
Degos et al. [124] HBV 2010 284 42 5.2 0.78 89 38 59
10 12.9 0.85 52 93 89
Sporea et al. [135] HBV 2010 140 76 7.0 0.65 59 70 n.a.
5 13.6 0.97 86 99 n.a.
Cardoso et al. [136] HBV 2012 202 42 7.2 0.87 74 88 82
8 11.0 0.93 75 90 89
Goyal et al. [137] HBV 2013 357 25 6.0 0.84 82 67 n.a.
6 11 0.93 81 95 n.a.
Afdhal et al. [129] HCV/HBV 2015 560** 66.7 8.4 0.73 58 75 70
14.8 12.8 0.90 76 85 80
HCV, chronic hepatitis C; HBV, chronic hepatitis B; AUROC, area under ROC curve; Se, sensitivity; Sp, specificity; CC, correctly classified: true positive and negative; n.a, not
available.
⁄More than half of patients with «clinical» cirrhosis; adapted to ALT levels.
⁄⁄Validation cohort: HCV 92%; HBV 8%.
aAdapted to LT levels.
8 Journal of Hepatology 2015 vol. xxx j xxx–xxx
Please cite this article in press as: EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J
Hepatol (2015), http://dx.doi.org/10.1016/j.jhep.2015.04.006
and 284 HBV patients), which prospectively compared the • When compared in HCV patients, the different
widely used patented tests (FibroTestÒ, FibroMeterÒ, and patented tests have similar levels of performance in
HepaScoreÒ) with the non-patented test (APRI), the AUROC val- diagnosing significant fibrosis and cirrhosis (A1)
ues for significant fibrosis ranged from 0.72 to 0.78 with no sig-
nificant differences among scores [124]. In patients with • Although non-patented tests might have lower
cirrhosis, the AUROC values were higher for all tests, ranging diagnostic accuracy than patented tests, they are not
from 0.77 to 0.86, with no significant differences among the associated with additional costs, are easy to calculate,
tests. Although non-patented tests such as the Forns index, and are widely available (A2)
FIB-4, and APRI were not as accurate as patented tests [125],
there are no additional costs, they are easy to calculate, and
are widely available.
Table 5. Diagnostic performance of TE for significant fibrosis (F P2) and cirrhosis (F4) in patients with viral hepatitis B and C.
Authors Etiologies Year Patient F≥2 F4 Cut-offs AUROC Se Sp CC
(n) (%) (%)
(kPa) (%) (%) (%)
Castera et al. [126] HCV 2005 183 74 7.1 0.83 67 89 73
25 12.5 0.95 87 91 90
Ziol et al. [127] HCV 2005 251 65 8.6 0.79 56 91 68
19 14.6 0.87 86 96 94
Arena et al. [86] HCV 2008 150 56 7.8 0.91 83 82 83
19 14.8 0.98 94 92 92
Lupsor et al. [128] HCV 2008 324 65 7.4 0.86 76 84 79
21 11.9 0.94 87 91 90
Wang et al. [134] HCV 2009 214 42 9.5 0.82 70 83 n.a.
19 12 0.93 79 85 n.a.
Degos et al. [124] HCV 2010 913 62 5.2 0.75 90 32 57
14 12.9 0.90 72 89 87
Zarski et al. [125] HCV 2012 382 47 5.2 0.82 97 35 64
14 12.9 0.93 77 90 88
Coco et al. [69] HBV (HCV) 2007 228 62 8.3 0.93 85 91 87
50* 14.0 0.96 78 98 88
Oliveri et al. [130] HBV 2008 188 26 7.5 0.97 94 88 90
20* 11.8 0.97 86 96 94
Marcellin et al. [131] HBV 2009 173 50 7.2 0.81 70 83 76
8 11.0 0.93 93 87 94
Chan et al. [132] HBV 2009 161 25 12-13.4a 0.93 98 75 85
Kim et al. [133] HBV 2009 91 43 9.7 0.80 82 59 62
Wang et al. [134] HBV 2009 88 42 8.0 0.86 80 77 n.a.
19 10.0 0.89 85 88 n.a.
Degos et al. [124] HBV 2010 284 42 5.2 0.78 89 38 59
10 12.9 0.85 52 93 89
Sporea et al. [135] HBV 2010 140 76 7.0 0.65 59 70 n.a.
5 13.6 0.97 86 99 n.a.
Cardoso et al. [136] HBV 2012 202 42 7.2 0.87 74 88 82
8 11.0 0.93 75 90 89
Goyal et al. [137] HBV 2013 357 25 6.0 0.84 82 67 n.a.
6 11 0.93 81 95 n.a.
Afdhal et al. [129] HCV/HBV 2015 560** 66.7 8.4 0.73 58 75 70
14.8 12.8 0.90 76 85 80
HCV, chronic hepatitis C; HBV, chronic hepatitis B; AUROC, area under ROC curve; Se, sensitivity; Sp, specificity; CC, correctly classified: true positive and negative; n.a, not
available.
⁄More than half of patients with «clinical» cirrhosis; adapted to ALT levels.
⁄⁄Validation cohort: HCV 92%; HBV 8%.
aAdapted to LT levels.
8 Journal of Hepatology 2015 vol. xxx j xxx–xxx
Please cite this article in press as: EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J
Hepatol (2015), http://dx.doi.org/10.1016/j.jhep.2015.04.006
