ISSN 1300-4948 | E-ISSN 2148-5607
Liver - Original Article
Diagnostic value of combined serum biomarkers for the evaluation of liver fibrosis in chronic hepatitis C infection: A multicenter, noninterventional, observational study
1 Department of Infectious Diseases, Karadeniz Technical University School of Medicine, Trabzon, Turkey  
2 Department of Infectious Diseases, Atatürk University School of Medicine, Erzurum, Turkey  
3 Department of Infectious Diseases, İzmir Atatürk Training and Research Hospital, İzmir, Turkey  
4 Department of Infectious Diseases, Ankara Training and Research Hospital, Ankara, Turkey  
5 Department of Infectious Diseaes, 25 Aralık State Hospital, Gaziantep, Turkey  
6 Department of Infectious Diseaes, Mersin University School of Medicine, Mersin, Turkey  
7 Department of Infectious Diseaes, Kocaeli, University School of Medicine, Kocaeli, Turkey  
8 Department of Infectious Diseaes, Bafra State Hospital, Samsun, Turkey  
9 Department of Infectious Diseaes, Pamukkale University School of Medicine, Denizli, Turkey  
10 Department of Infectious Diseaes, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey  
11 Department of Infectious Diseaes, Kilis State Hospital, Kilis, Turkey  
12 Department of Infectious Diseaes, Giresun A. İlhan Özdemir State Hospital, Giresun, Turkey  
13 Department of Infectious Diseaes, Yıldırım Beyazıt University Atatürk Training and Research Hospital, Ankara, Turkey  
14 Department of Infectious Diseaes, Dokuz Eylül University School of Medicine, İzmir, Turkey  
15 Department of Infectious Diseaes, Eşrefpaşa State Hospital, İzmir, Turkey  
16 Department of Infectious Diseaes, Kayseri Training and Research Hospital, Kayseri, Turkey  
17 Department of Clinical Research, Roche Pharmaceuticals, İstanbul, Turkey  
18 The Chronic Hepatitis C Study Group  
Turk J Gastroenterol 2018; 29: 464-472
DOI: 10.5152/tjg.2018.16597
Key Words: Chronic hepatitis C infection, liver fibrosis, FibroTest, APRI, Forns index, Fib-4, non-invasive serum biomarkers
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.


Cite this article as
: Köksal İ, Yılmaz G, Parlak M, et al. Diagnostic value of combined serum biomarkers for the evaluation of liver fibrosis in chronic hepatitis C infection: A multicenter, noninterventional, observational study. Turk J Gastroenterol 2018; 29: 464-72.

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