Prospective comparison of two algorithms combining non-invasive methods for staging liver fibrosis in chronic hepatitis C☆
Received 29 May 2009; received in revised form 6 August 2009; accepted 1 September 2009. published online 24 November 2009.
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.
☆ Part of this work has been presented as oral presentation at the 58th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD), Boston (USA), November 2–6, 2007.
ABSTRACT