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Meta-Analysis
. 2016 Jan;43(1):16-29.
doi: 10.1111/apt.13446. Epub 2015 Oct 30.

Systematic review with meta-analysis: direct comparisons of biomarkers for the diagnosis of fibrosis in chronic hepatitis C and B

M Houot  1 , Y Ngo  1 , M Munteanu  1 , S Marque  2 , T Poynard  3   4
Affiliations
Meta-Analysis

Systematic review with meta-analysis: direct comparisons of biomarkers for the diagnosis of fibrosis in chronic hepatitis C and B

M Houot et al. Aliment Pharmacol Ther. 2016 Jan.

Abstract

Background: Blood tests and transient elastography (TE), proposed as alternatives to biopsy for identifying advanced fibrosis (METAVIR-stage-F2 or greater) or cirrhosis, have never been compared using an intention to diagnose approach, with direct comparisons only, and Bayesian approach.

Aim: To permit more appropriate comparisons.

Methods: From an overview of articles (2002-2014), we selected studies that directly compared the diagnostic accuracy of FibroTest, aspartate aminotransferase-platelet ratio index (APRI), FIB4 or TE, with biopsy as a reference, in patients with chronic hepatitis C (CHC) or B (CHB). Investigators abstracted and checked study details and quality by using pre-defined criteria. Bayesian method in intention to diagnose was the primary outcome.

Results: Of 1321 articles identified, 71 studies including 77 groups according to aetiology (All-CB) were eligible: 37 Only-C, 28 Only-B and 12 Mixed-C-B. There were 185 direct comparisons between the area under the ROC curves (AUROCs), 99 for the diagnosis of advanced fibrosis and 86 for cirrhosis. In All-CB, Bayesian analyses revealed significant AUROCs differences in identifying advanced fibrosis in favour of FibroTest vs. TE [credibility interval: 0.06(0.02-0.09)], FibroTest vs. APRI [0.05 (0.03-0.07)] and for identifying cirrhosis TE vs. APRI [0.07 (0.02-0.13)] and FIB4 vs. APRI [0.04(0.02-0.05)]. No differences were observed between TE and FibroTest, for identifying cirrhosis in All-CB, and in sub-groups (Only-C, Only-B, Mixed-CB) for both cirrhosis and fibrosis.

Conclusions: In CHC and CHB, APRI had lower performances than FIB-4, TE and FibroTest. TE had lower performance than FibroTest for identifying advanced fibrosis in All-CB, without significant difference for identifying cirrhosis in all groups.

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Figures

Figure 1
Figure 1
Direct comparisons between APRI, FIB4, FibroTest and TE. (a) Direct comparisons of biomarkers performance in All‐CB patients. Of the 185 comparisons, 28 (15/13) (15 Fibrosis F2F3F4/13 cirrhosis F4) involved FibroTest vs. TE, 35 (21/14) FibroTest vs. APRI, 11 (5/6) FibroTest vs. FIB4, 35 (21/14) TE vs. APRI, 13 (6/7) TE vs. FIB4 and 63 (35/28) APRI vs. FIB4. (b) Direct comparisons of biomarkers performance in Only‐C patients. Of the 88 comparisons, 5 (2/3) (2 F2F3F4/ 3 F4) involved FibroTest vs. TE, 17 (11/6) FibroTest vs. APRI, 5 (2/3) FibroTest vs. FIB4, 20 (10/10) TE vs. APRI, 7 (3/4) TE vs. FIB4 and 34 (19/15) APRI vs. FIB4. (c) Direct comparisons of biomarkers performance in Mixed‐CB patients. Of the 34 comparisons, 12 (7/5) involved FibroTest vs. TE, 5 (3/2) FibroTest vs. APRI, 2 (1/1) FibroTest vs. FIB4, 8 (4/4) TE vs. APRI, 4 (2/2) TE vs. FIB4 and 5 (2/3) APRI vs. FIB4. (d) Direct comparisons of biomarkers performance in Only‐B patients. Of the 63 comparisons, 11 (6/5) involved FibroTest vs. TE, 13 (7/6) FibroTest vs. APRI, 4 (2/2) FibroTest vs. FIB4, 7 (3/4) TE vs. APRI, 4 (2/2) TE vs. FIB4, and 24 (14/10) APRI vs. FIB4.
Figure 2
Figure 2
Meta‐analysis of direct comparisons in chronic hepatitis C and B (All‐CB) for identifying advanced fibrosis.
Figure 3
Figure 3
Meta‐analysis of direct comparisons in chronic hepatitis C and B (All‐CB) for identifying cirrhosis.
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Comment in

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