Non invasive fibrosis biomarkers reduce but not substitute the need for liver biopsy

Table 8 Diagnostic performance of APRI, Forns’ index, Fibrotest and of sequential algorithms combining the three markers in patients with chronic hepatitis C

	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	Accuracy (%)	AUC	Classified patients(%)
Detection of significant fibrosis in chronic hepatitis C with elevated ALT
APRI	29.7	93.8	95.7	52.7	60.2	0.69	54.1
Fibrotest	65	80.6	80	66.7	72.6	0.81	100
Forns	24.3	98.3	94.7	50.9	57.1	0.79	55.5
Sequential algorithm	100	83.8	92.7	100	94.2	n.a.	100
Detection of significant fibrosis in chronic hepatitis C with PNALT
APRI	26.9	100	100	56.8	62.7	0.77	74
Fibrotest	58.3	91.3	77.7	80.7	80	0.71	100
Forns	11.5	100	100	52.1	54.9	0.58	56
Sequential algorithm	100	87.5	94.3	100	96.3	n.a.	100
Detection of cirrhosis in chronic hepatitis C
APRI	38.4	86.7	38.5	86.7	78.1	0.61	54.1
Fibrotest	50	92.9	57.9	90.5	85.9	0.71	100
Sequential algorithm	94.6	95.1	78.3	99.1	95.5	n.a.	100

PPV = positive predictive value; NPV = negative predictive value; AUC = area under the curve; APRI = aspartate aminotrasferase to platelets ratio; Forns = Forns’ index; n.a. = not available; PNALT = persistently normal ALT.