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. 2017 Mar 18;9(8):436-442.
doi: 10.4254/wjh.v9.i8.436.

Concordance of non-invasive mechanical and serum tests for liver fibrosis evaluation in chronic hepatitis C

Denise C Paranaguá-Vezozzo  1 , Adriana Andrade  1 , Daniel F C Mazo  1 , Vinicius Nunes  1 , Ana L Guedes  1 , Taisa G Ragazzo  1 , Renata Moutinho  1 , Lucas S Nacif  1 , Suzane K Ono  1 , Venâncio A F Alves  1 , Flair J Carrilho  1
Affiliations

Concordance of non-invasive mechanical and serum tests for liver fibrosis evaluation in chronic hepatitis C

Denise C Paranaguá-Vezozzo et al. World J Hepatol. .

Abstract

Aim: To determine the sensitivity and specificity of liver stiffness measurement (LSM) and serum markers (SM) for liver fibrosis evaluation in chronic hepatitis C.

Methods: Between 2012 and 2014, 81 consecutive hepatitis C virus (HCV) patients had METAVIR score from liver biopsy compared with concurrent results from LSM [transient elastography (TE) [FibroScan®/ARFI technology (Virtual Touch®)] and SM [FIB-4/aspartate aminotransferase-to-platelet ratio index (APRI)]. The diagnostic performance of these tests was assessed using receiver operating characteristic curves. The optimal cut-off levels of each test were chosen to define fibrosis stages F ≥ 2, F ≥ 3 and F = 4. The Kappa index set the concordance analysis.

Results: Fifty point six percent were female and the median age was 51 years (30-78). Fifty-six patients (70%) were treatment-naïve. The optimal cut-off values for predicting F ≥ 2 stage fibrosis assessed by TE were 6.6 kPa, for acoustic radiation force impulse (ARFI) 1.22 m/s, for APRI 0.75 and for FIB-4 1.47. For F ≥ 3 TE was 8.9 kPa, ARFI was 1.48 m/s, APRI was 0.75, and FIB-4 was 2. For F = 4, TE was 12.2 kPa, ARFI was 1.77 m/s, APRI was 1.46, and FIB-4 was 3.91. The APRI could not distinguish between F2 and F3, P = 0.92. The negative predictive value for F = 4 for TE and ARFI was 100%. Kappa index values for F ≥ 3 METAVIR score for TE, ARFI and FIB-4 were 0.687, 0.606 and 0.654, respectively. This demonstrates strong concordance between all three screening methods, and moderate to strong concordance between them and APRI (Kappa index = 0.507).

Conclusion: Given the costs and accessibility of LSM methods, and the similarity with the outcomes of SM, we suggest that FIB-4 as well as TE and ARFI may be useful indicators of the degree of liver fibrosis. This is of particular importance to developing countries.

Keywords: Elastography; Hepatitis C virus; Liver biopsy; Liver stiffness; Serum markers.

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Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.

Figures

Figure 1
Figure 1
Flowchart of study population enrollment. HCV: Hepatitis C virus; HBV: Hepatitis B virus; HIV: Human immunodeficiency virus.
Figure 2
Figure 2
Rate of agreement of transient elastography, acoustic radiation force impulse, aspartate aminotransferase-to-platelet ratio index and FIB-4 according to Metavir fibrosis stage (%). TE: Transient elastography; ARFI: Acoustic radiation force impulse; FIB-4: Score index (age × AST/platelet × ALT).
See this image and copyright information in PMC

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