Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 18, 2017; 9(8): 436-442
Published online Mar 18, 2017. doi: 10.4254/wjh.v9.i8.436
Concordance of non-invasive mechanical and serum tests for liver fibrosis evaluation in chronic hepatitis C
Denise C Paranaguá-Vezozzo, Adriana Andrade, Daniel F C Mazo, Vinicius Nunes, Ana L Guedes, Taisa G Ragazzo, Renata Moutinho, Lucas S Nacif, Suzane K Ono, Venâncio A F Alves, Flair J Carrilho
Denise C Paranaguá-Vezozzo, Adriana Andrade, Daniel F C Mazo, Vinicius Nunes, Ana L Guedes, Taisa G Ragazzo, Renata Moutinho, Lucas S Nacif, Suzane K Ono, Flair J Carrilho, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, Sao Paulo 05403-900, Brazil
Daniel F C Mazo, Division of Gastroenterology, School of Medical Sciences, State University of Campinas, Sao Paulo 13083-970, Brazil
Venâncio A F Alves, Department of Pathology, University of São Paulo School of Medicine, Sao Paulo 01246-903, Brazil
Author contributions: Paranaguá-Vezozzo DC, Andrade A, Nacif LS conceived and designed the study, contributed to the data analysis and interpretation and wrote the manuscript; Nunes V, Guedes AL, Regazzo TG and Moutinho R collected and assembled the data; Mazo DFC, Ono SK, Alves VAF, Carrilho FJ contributed to the data analysis and interpretation; all authors approved the final form of the article.
Institutional review board statement: The study was reviewed and approved by the CAPPesq, the Ethics Committee for researches of the institution (CAAE number: 1276/09).
Informed consent statement: Institutional review board approval was obtained and the requirement for informed written consent was waived.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Daniel F C Mazo, MD, PhD, Division of Clinical Gastroenterology and Hepatology, Hospital das Clínicas, Department of Gastroenterology, University of São Paulo School of Medicine, Avenida Dr. Eneas Carvalho de Aguiar, 255, sala 9159, São Paulo 05403-900, Brazil. daniel.mazo@hc.fm.usp.br
Telephone: +55-11-26617830 Fax: +55-11-26617830
Received: October 11, 2016
Peer-review started: October 12, 2016
First decision: December 13, 2016
Revised: January 9, 2017
Accepted: February 8, 2017
Article in press: February 13, 2017
Published online: March 18, 2017
Processing time: 153 Days and 6.3 Hours
Abstract
AIM

To determine the sensitivity and specificity of liver stiffness measurement (LSM) and serum markers (SM) for liver fibrosis evaluation in chronic hepatitis C.

METHODS

Between 2012 and 2014, 81 consecutive hepatitis C virus (HCV) patients had METAVIR score from liver biopsy compared with concurrent results from LSM [transient elastography (TE) [FibroScan®/ARFI technology (Virtual Touch®)] and SM [FIB-4/aspartate aminotransferase-to-platelet ratio index (APRI)]. The diagnostic performance of these tests was assessed using receiver operating characteristic curves. The optimal cut-off levels of each test were chosen to define fibrosis stages F ≥ 2, F ≥ 3 and F = 4. The Kappa index set the concordance analysis.

RESULTS

Fifty point six percent were female and the median age was 51 years (30-78). Fifty-six patients (70%) were treatment-naïve. The optimal cut-off values for predicting F ≥ 2 stage fibrosis assessed by TE were 6.6 kPa, for acoustic radiation force impulse (ARFI) 1.22 m/s, for APRI 0.75 and for FIB-4 1.47. For F ≥ 3 TE was 8.9 kPa, ARFI was 1.48 m/s, APRI was 0.75, and FIB-4 was 2. For F = 4, TE was 12.2 kPa, ARFI was 1.77 m/s, APRI was 1.46, and FIB-4 was 3.91. The APRI could not distinguish between F2 and F3, P = 0.92. The negative predictive value for F = 4 for TE and ARFI was 100%. Kappa index values for F ≥ 3 METAVIR score for TE, ARFI and FIB-4 were 0.687, 0.606 and 0.654, respectively. This demonstrates strong concordance between all three screening methods, and moderate to strong concordance between them and APRI (Kappa index = 0.507).

CONCLUSION

Given the costs and accessibility of LSM methods, and the similarity with the outcomes of SM, we suggest that FIB-4 as well as TE and ARFI may be useful indicators of the degree of liver fibrosis. This is of particular importance to developing countries.

Keywords: Elastography; Serum markers; Hepatitis C virus; Liver stiffness; Liver biopsy

Core tip: Liver fibrosis evaluation in hepatitis C virus (HCV) patients has critical impact on prognosis and treatment strategies. Despite liver biopsy (LB) remains the gold standard for its evaluation, non invasive methods has improved in recent years. We evaluated 81 HCV patients with elastography methods [Fibroscan and acoustic radiation force impulse (ARFI)] and serum markers (APRI and FIB-4) compared to LB, and found that Fibroscan, ARFI, and FIB-4 independently identify advanced fibrosis. We suggest that FIB-4 alongside Fibroscan and ARFI may be good tools for the prediction of severity of liver fibrosis. This may be of particular importance to developing countries.