Validation and comparison of simple noninvasive models for the prediction of liver fibrosis in chronic hepatitis C
Introduction. Although it is standard procedure in the evaluation of liver diseases, biopsy is an invasive method subject to sampling error and intra or inter-observer variability. Thus, surrogate markers of liver fibrosis have been proposed, with variable availability and accuracy.Aim. Validate and...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2012-11-01
|
| Series: | Annals of Hepatology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268119314103 |
| _version_ | 1818602753996357632 |
|---|---|
| author | Thabata Glenda Fenili Amorim Guilherme Jönck Staub César Lazzarotto André Pacheco Silva Joice Manes Maria da Graça Ferronato Maria Beatriz Cacese Shiozawa Janaína Luz Narciso-Schiavon Esther Buzaglo Dantas-Correa Leonardo de Lucca Schiavon, M.D., Ph.D. |
| author_facet | Thabata Glenda Fenili Amorim Guilherme Jönck Staub César Lazzarotto André Pacheco Silva Joice Manes Maria da Graça Ferronato Maria Beatriz Cacese Shiozawa Janaína Luz Narciso-Schiavon Esther Buzaglo Dantas-Correa Leonardo de Lucca Schiavon, M.D., Ph.D. |
| author_sort | Thabata Glenda Fenili Amorim |
| collection | DOAJ |
| description | Introduction. Although it is standard procedure in the evaluation of liver diseases, biopsy is an invasive method subject to sampling error and intra or inter-observer variability. Thus, surrogate markers of liver fibrosis have been proposed, with variable availability and accuracy.Aim. Validate and compare the performance of APRI and FIB-4 as predictors of liver fibrosis in HCV patients.Material and methods. Cross-sectional study including patients with HCV-RNA (+) who underwent liver biopsy. Significant fibrosis was defined as METAVIR stage ≥ 2. The diagnostic performance of the models in predicting significant fibrosis were evaluated and compared by ROC curves.Results. The study included 119 patients, mean age 43.7 ± 10.6 years and 62% males. Significant fibrosis was identified in 41 patients. The AUROCs observed were: APRI = 0.793 ± 0.047, FIB-4 = 0.811 ± 0.045 and AST/ALT = 0.661 ± 0.055 (P = 0.054 for APRI vs. AST/ALT, and P = 0.014 for FIB-4 vs. AST/ALT). Considering classic cutoffs, the PPV and NPV for APRI and FIB-4 were, respectively, 77% and 92% and 83% and 81%. Thirteen (19%) patients were misdiagnosed by APRI and 16 (18%) by FIB-4. By restricting the indication of liver biopsy to patients with intermediate values, it could have been correctly avoided in 47% and 63% of the patients with APRI and FIB-4, respectively.Conclusion. The models APRI and FIB-4 were superior to AST/ALT ratio in the diagnosis of significant fibrosis in chronic HCV infection. Even though the overall performance of APRI and FIB-4 was similar, a higher proportion of patients may be correctly classified by FIB-4. |
| first_indexed | 2024-12-16T13:12:18Z |
| format | Article |
| id | doaj.art-5e361bddcb74499f86de8ae11786b4f1 |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-12-16T13:12:18Z |
| publishDate | 2012-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-5e361bddcb74499f86de8ae11786b4f12022-12-21T22:30:34ZengElsevierAnnals of Hepatology1665-26812012-11-01116855861Validation and comparison of simple noninvasive models for the prediction of liver fibrosis in chronic hepatitis CThabata Glenda Fenili Amorim0Guilherme Jönck Staub1César Lazzarotto2André Pacheco Silva3Joice Manes4Maria da Graça Ferronato5Maria Beatriz Cacese Shiozawa6Janaína Luz Narciso-Schiavon7Esther Buzaglo Dantas-Correa8Leonardo de Lucca Schiavon, M.D., Ph.D.9Núcleo de Estudos em Gastroenterologia e Hepatologia (NEGH), Gastroenterology Division, Federal University of Santa Catarina. BrazilNúcleo de Estudos em Gastroenterologia e Hepatologia (NEGH), Gastroenterology Division, Federal University of Santa Catarina. BrazilNúcleo de Estudos em Gastroenterologia e Hepatologia (NEGH), Gastroenterology Division, Federal University of Santa Catarina. BrazilNúcleo de Estudos em Gastroenterologia e Hepatologia (NEGH), Gastroenterology Division, Federal University of Santa Catarina. BrazilNúcleo de Estudos em Gastroenterologia e Hepatologia (NEGH), Gastroenterology Division, Federal University of Santa Catarina. BrazilNúcleo de Estudos em Gastroenterologia e Hepatologia (NEGH), Gastroenterology Division, Federal University of Santa Catarina. BrazilDepartment of Pathology, Federal University of Santa Catarina. BrazilNúcleo de Estudos em Gastroenterologia e Hepatologia (NEGH), Gastroenterology Division, Federal University of Santa Catarina. BrazilNúcleo de Estudos em Gastroenterologia e Hepatologia (NEGH), Gastroenterology Division, Federal University of Santa Catarina. BrazilNúcleo de Estudos em Gastroenterologia e Hepatologia (NEGH), Gastroenterology Division, Federal University of Santa Catarina. Brazil; Correspondence and reprint request:Introduction. Although it is standard procedure in the evaluation of liver diseases, biopsy is an invasive method subject to sampling error and intra or inter-observer variability. Thus, surrogate markers of liver fibrosis have been proposed, with variable availability and accuracy.Aim. Validate and compare the performance of APRI and FIB-4 as predictors of liver fibrosis in HCV patients.Material and methods. Cross-sectional study including patients with HCV-RNA (+) who underwent liver biopsy. Significant fibrosis was defined as METAVIR stage ≥ 2. The diagnostic performance of the models in predicting significant fibrosis were evaluated and compared by ROC curves.Results. The study included 119 patients, mean age 43.7 ± 10.6 years and 62% males. Significant fibrosis was identified in 41 patients. The AUROCs observed were: APRI = 0.793 ± 0.047, FIB-4 = 0.811 ± 0.045 and AST/ALT = 0.661 ± 0.055 (P = 0.054 for APRI vs. AST/ALT, and P = 0.014 for FIB-4 vs. AST/ALT). Considering classic cutoffs, the PPV and NPV for APRI and FIB-4 were, respectively, 77% and 92% and 83% and 81%. Thirteen (19%) patients were misdiagnosed by APRI and 16 (18%) by FIB-4. By restricting the indication of liver biopsy to patients with intermediate values, it could have been correctly avoided in 47% and 63% of the patients with APRI and FIB-4, respectively.Conclusion. The models APRI and FIB-4 were superior to AST/ALT ratio in the diagnosis of significant fibrosis in chronic HCV infection. Even though the overall performance of APRI and FIB-4 was similar, a higher proportion of patients may be correctly classified by FIB-4.http://www.sciencedirect.com/science/article/pii/S1665268119314103Liver cirrhosisBiomarkersDiagnosis |
| spellingShingle | Thabata Glenda Fenili Amorim Guilherme Jönck Staub César Lazzarotto André Pacheco Silva Joice Manes Maria da Graça Ferronato Maria Beatriz Cacese Shiozawa Janaína Luz Narciso-Schiavon Esther Buzaglo Dantas-Correa Leonardo de Lucca Schiavon, M.D., Ph.D. Validation and comparison of simple noninvasive models for the prediction of liver fibrosis in chronic hepatitis C Annals of Hepatology Liver cirrhosis Biomarkers Diagnosis |
| title | Validation and comparison of simple noninvasive models for the prediction of liver fibrosis in chronic hepatitis C |
| title_full | Validation and comparison of simple noninvasive models for the prediction of liver fibrosis in chronic hepatitis C |
| title_fullStr | Validation and comparison of simple noninvasive models for the prediction of liver fibrosis in chronic hepatitis C |
| title_full_unstemmed | Validation and comparison of simple noninvasive models for the prediction of liver fibrosis in chronic hepatitis C |
| title_short | Validation and comparison of simple noninvasive models for the prediction of liver fibrosis in chronic hepatitis C |
| title_sort | validation and comparison of simple noninvasive models for the prediction of liver fibrosis in chronic hepatitis c |
| topic | Liver cirrhosis Biomarkers Diagnosis |
| url | http://www.sciencedirect.com/science/article/pii/S1665268119314103 |
| work_keys_str_mv | AT thabataglendafeniliamorim validationandcomparisonofsimplenoninvasivemodelsforthepredictionofliverfibrosisinchronichepatitisc AT guilhermejonckstaub validationandcomparisonofsimplenoninvasivemodelsforthepredictionofliverfibrosisinchronichepatitisc AT cesarlazzarotto validationandcomparisonofsimplenoninvasivemodelsforthepredictionofliverfibrosisinchronichepatitisc AT andrepachecosilva validationandcomparisonofsimplenoninvasivemodelsforthepredictionofliverfibrosisinchronichepatitisc AT joicemanes validationandcomparisonofsimplenoninvasivemodelsforthepredictionofliverfibrosisinchronichepatitisc AT mariadagracaferronato validationandcomparisonofsimplenoninvasivemodelsforthepredictionofliverfibrosisinchronichepatitisc AT mariabeatrizcaceseshiozawa validationandcomparisonofsimplenoninvasivemodelsforthepredictionofliverfibrosisinchronichepatitisc AT janainaluznarcisoschiavon validationandcomparisonofsimplenoninvasivemodelsforthepredictionofliverfibrosisinchronichepatitisc AT estherbuzaglodantascorrea validationandcomparisonofsimplenoninvasivemodelsforthepredictionofliverfibrosisinchronichepatitisc AT leonardodeluccaschiavonmdphd validationandcomparisonofsimplenoninvasivemodelsforthepredictionofliverfibrosisinchronichepatitisc |