Prospective comparison of two algorithms combining non-invasive methods for staging liver fibrosis in chronic hepatitis C☆

Background & Aims

Non-invasive assessment of liver fibrosis is a challenging area. Several methods have been proposed in patients with chronic hepatitis C (CHC) but their performance may be improved when they are combined as suggested by recently proposed algorithms using either transient elastography (TE) and Fibrotest (FT) (Castera) or AST-to-Platelet Ratio Index (APRI) and FT (SAFE biopsy). The aim of this prospective study was to compare the performance of these two algorithms for diagnosing significant fibrosis and cirrhosis in 302 CHC patients.

Methods

All patients underwent TE, FT and APRI the same day as liver biopsy, taken as reference standard.

Results

Significant fibrosis (Metavir F⩾2) was present in 76% of patients and cirrhosis (F4) in 25%. TE failure was observed in eight cases (2.6%). For significant fibrosis, Castera algorithm saved 23% more liver biopsies (71.9% vs. 48.3%, respectively; p<0.0001) than SAFE biopsy but its accuracy was significantly lower (87.7% vs. 97.0%, respectively; p<0.0001). Regarding cirrhosis, accuracy of Castera algorithm was significantly higher than that of SAFE biopsy (95.7% vs. 88.7%, respectively; p<0.0001). The number of saved liver biopsies did not differ between the two algorithms (78.8% vs. 74.8%; p=NS).

Conclusions

Both algorithms are effective for non-invasive staging of liver fibrosis in chronic hepatitis C. Although the number of liver biopsies avoided does not differ between algorithms for diagnosing cirrhosis, it is significantly higher with Castera algorithm than SAFE biopsy for significant fibrosis.

Abbreviations: CHC, chronic hepatitis C, TE, transient elastography, FT, Fibrotest, APRI, AST-to-platelet ratio, SAFE, sequential algorithms for fibrosis evaluation, HCV, hepatitis C virus, HBV, hepatitis B virus, kPa, kilopascal, IQR, interquartile range, AUROC, area under the ROC curve, DANA, difference between advanced and non-advanced fibrosis

Keywords: Hepatitis C, Fibrosis, Non-invasive, FibroScan, Fibrotest, APRI