Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 Jul;29(4):464-472.
doi: 10.5152/tjg.2018.16597.

Diagnostic value of combined serum biomarkers for the evaluation of liver fibrosis in chronic hepatitis C infection: A multicenter, noninterventional, observational study

İftihar Köksal  1 , Gürdal Yılmaz  1 , Mehmet Parlak  2 , Tuna Demirdal  3 , Sami Kınıklı  4 , Mehmet Candan  5 , Ali Kaya  6 , Sıla Akhan  7 , Özcan Aydoğdu  8 , Hüseyin Turgut  9 , Yunus Gürbüz  10 , Özgür Dağlı  11 , Ahmet Ali Gökal  12 , Rahmet Güner  13 , Ziya Kuruüzüm  14 , Hüseyin Tarakçı  15 , Nuri Beslen  16 , Seda Erdoğan  17 , Fatih Özdener  17 , The Chronic Hepatitis C Study Group
Affiliations
Observational Study

Diagnostic value of combined serum biomarkers for the evaluation of liver fibrosis in chronic hepatitis C infection: A multicenter, noninterventional, observational study

İftihar Köksal et al. Turk J Gastroenterol. 2018 Jul.

Abstract

Background/aims: The hepatitis C virus (HCV) infection is important cause of chronic hepatitis. Liver biopsy is considered the gold standard for assessment of fibrosis but this procedure is an invasive procedure. We aimed to evaluate the diagnostic efficiency of non-invasive serum biomarkers, separately and in combinations, on liver fibrosis in treatment-naive chronic hepatitis C (CHC) patients.

Materials and methods: Two hundred and sixteen treatment-naive CHC patients were enrolled from 32 locations across Turkey in this open-labelled, non-interventional prospective observational study. FibroTest®, aspartate aminotransferase-to-platelet ratio index(APRI), aspartate aminotransferase and alanine aminotransferase ratio (AAR), fibrosis index based on four factors (FIB-4), Age-platelet(AP) index and Forns index were measured and compared with Metavir scores got from liver biopsies.

Results: Data from 182 patients with baseline liver biopsy were suitable for analysis. One hundred and twenty patients (65.9%) had F0-F1 fibrosis and 62 patients (34.1%) had F2-F4 fibrosis. APRI 0.732 area under the curve(AUC) indicated advanced fibrosis with 69% sensitivity and 77% specificity. FIB-4 0.732 AUC and FibroTest 0.715 AUC indicated advanced fibrosis with 69% and 78.4% sensitivity, and 75% and 71.4% specificity, respectively. The combined use of tests also led to an increase in AUC and specificity. Combinations of FibroTest with APRI and/or FIB-4, and FIB-4 with APRI were optimal for the evaluation of liver fibrosis.

Conclusion: Fibrotest, FIB-4, APRI, AP index and Forns index exhibit good diagnostic performance for determining liver fibrosis in CHC patients, and the use of at least two tests together will increase their diagnostic value still further.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
ROC curve analysis of noninvasive tests for diagnosis of liver fibrosis
Figure 2
Figure 2
Error bar graphic images of FibroTest for diagnosis of liver fibrosis
Figure 3
Figure 3
Error bar graphic images of APRI for diagnosis of liver fibrosis
Figure 4
Figure 4
Error bar graphic images of FIB-4 for diagnosis of liver fibrosis
Figure 5
Figure 5
Error bar graphic images of the Forns index for diagnosis of liver fibrosis
Figure 6
Figure 6
Error bar graphic images of the AP index for diagnosis of liver fibrosis
Figure 7
Figure 7
Error bar graphic images of AAR for diagnosis of liver fibrosis
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Messina JP, Humphreys I, Flaxman A, et al. Global distribution and prevalence of hepatitis C virus genotypes. Hepatology. 2015;61:77–87. doi: 10.1002/hep.27259. - DOI - PMC - PubMed
    1. Tozun N, Ozdogan O, Cakaloglu Y, et al. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study. Clin Microbiol Infect. 2015;21:1020–6. doi: 10.1016/j.cmi.2015.06.028. - DOI - PubMed
    1. de Schiavon LL, Narciso-Schiavon JL, de Carvalho-Filho RJ. Non-invasive diagnosis of liver fibrosis in chronic hepatitis C. World J Gastroenterol. 2014;20:2854–66. doi: 10.3748/wjg.v20.i11.2854. - DOI - PMC - PubMed
    1. Gebo KA, Herlong HF, Torbenson MS, et al. Role of liver biopsy in management of chronic hepatitis C: a systematic review. Hepatology. 2002;36:S161–72. doi: 10.1002/hep.1840360721. - DOI - PubMed
    1. Saadeh S, Cammell G, Carey WD, Younossi Z, Barnes D, Easley K. The role of liver biopsy in chronic hepatitis C. Hepatology. 2001;33:196–200. doi: 10.1053/jhep.2001.20534. - DOI - PubMed

Publication types

MeSH terms