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©The Author(s) 2025.
World J Hepatol. Mar 27, 2025; 17(3): 104534
Published online Mar 27, 2025. doi: 10.4254/wjh.v17.i3.104534
Published online Mar 27, 2025. doi: 10.4254/wjh.v17.i3.104534
Table 1 Characteristics of participants
| Characteristics | Included patients (n = 103) |
| Demographic | |
| Age (years), median (IQR) | 53 (38-61) |
| Female | 86 (83) |
| BMI, median (IQR) | 26 (21-28) |
| Baseline histological features (METAVIR) | |
| Biopsy specimen length (mm), median (IQR) | 12 (11-15) |
| F0 | 10 (10) |
| F1 | 28 (27) |
| F2 | 21 (20) |
| F3 | 24 (23) |
| F4 | 20 (19) |
| Fibrosis ≥ F2 | 65 (63) |
| Fibrosis ≥ F3 | 44 (43) |
| Cirrhosis F4 | 20 (19) |
| A0 | 10 (10) |
| A1 | 30 (29) |
| A2 | 42 (41) |
| A3 | 21 (20) |
| Activity ≥ A2 | 63 (61) |
| Steatosis > 0 | 12 (12) |
| Biopsy diagnosis | |
| AIH | 83 (81) |
| AIH and MASLD | 1 (1) |
| AIH and PBC | 19 (18) |
| NITs for significant fibrosis (≥ F2) | |
| FibroTest > 0.48 | 55 (53) |
| FIB-4 ≥ 1.3 | 66 (64) |
| VCTE ≥ 8 kPa | 61 (59) |
| NITs for advanced activity (≥ A2) | |
| ActiTest > 0.52 | 48 (47) |
| ALT ≥ 50 | 63 (61) |
| Other serum components, median (IQR) | |
| ALT (IU/L) | 67 (37-160) |
| AST (IU/L) | 52 (34-117) |
| GGT (IU/L) | 73 (31-170) |
| Total bilirubin, μmol/L | 16.7 (11-25) |
| Apolipoprotein-A1 (g/L) | 1.57 (1.25-1.80) |
| Haptoglobin (g/L) | 0.58 (0.56-1.30) |
| Alpha-2 macroglobulin (g/L) | 2.34 (1.93-2.88) |
| Platelets (g/L) | 201 (156-266) |
Table 2 Test performance according to statistical methods by features
| Features and test | Obuchowski weighted AUROC mean (standard error) | Standard binary AUROC mean (95%CI) | ||
| Fibrosis | 5 stages, 10 comparisons | F2, F3, F4 vs F0, F1 | F3, F4 vs F0, F1, F2 | F4 vs F0, F1, F2, F3 |
| FibroTest | 0.919 (0.014) | 0.83 (0.73-0.90) | 0.83 (0.73-0.90) | 0.80 (0.68-0.88) |
| VCTE | 0.933 (0.014) | 0.86 (0.77-0.92) | 0.87 (0.78-0.93) | 0.87 (0.78-0.94) |
| FIB-4 | 0.882 (0.019) | 0.71 (0.60-0.80) | 0.75 (0.63-0.83) | 0.80 (0.67-0.89) |
| Activity | 4 stages, 8 comparisons | A2, A3 vs A0, A1 | - | - |
| ActiTest | 0.921 (0.016) | 0.86 (0.76-0.92) | - | - |
| ALT | 0.905 (0.019) | 0.83 (0.73-0.90) | - | - |
Table 3 Diagnostic performance of biopsy, FibroTest, fibrosis-4 index, and vibration-controlled transient elastography for significant fibrosis (F2, F3, and F4) and advanced fibrosis (F3 and F4) compared with that of the gold standard model and Bayesian latent class model
| Parameters and cutoffs | Biopsy assumed as perfect reference | Bayesian LCM | Gold standard model vs LCM |
| Number of patients | 103 | 103 | Difference (Z-test P-value) |
| Prevalence significant fibrosis | 63.1 (53.0-72.2) | 66.2 (56.0-77.0) | 3.1% increase (0.67) |
| Biopsy stage METAVIR ≥ F2 | |||
| Sensitivity | 100 | 95.4 (83.1-100) | 4.6% decrease (NA) |
| Specificity | 100 | 100 (100-100) | NA (NA) |
| Positive predictive value | 100 | 100 (100-100) | NA (NA) |
| Negative predictive value | 100 | 91.9 (67.3-99.9) | 8.1% decrease (NA) |
| FibroTest with cutoff of > 0.48 | |||
| Sensitivity | 73.8 (61.2-83.6) | 73.1 (61.5-82.6) | 0.7% decrease (0.93) |
| Specificity | 81.6 (65.1-91.7) | 86.1 (70.6-98.4) | 4.5% increase (0.69) |
| Positive predictive value | 87.3 (74.9-94.3) | 91.1 (79.9-99.1) | 3.8% increase (0.65) |
| Negative predictive value | 64.6 (49.4-77.4) | 62.0 (45.7-75.4) | 2.6% decrease (0.82) |
| FIB-4 with cutoff of ≥ 1.3 | |||
| Sensitivity | 69.2 (56.4-79.8) | 70.0 (58.6-80.2) | 0.8% increase (0.93) |
| Specificity | 44.7 (29.0-61.5) | 49.8 (40.8-66.1) | 5.1% increase (0.58) |
| Positive predictive value | 68.2 (55.4-78.8) | 73.5 (61.5-85.0) | 5.3% increase (0.55) |
| Negative predictive value | 45.9 (29.8-62.9) | 46.1 (31.2-61.9) | 0.2% increase (0.99) |
| VCTE with LSM cutoff of ≥ 8 kPa | |||
| Sensitivity | 81.5 (69.6-89.7) | 80.7 (69.9-89.2) | 0.8% decrease (0.92) |
| Specificity | 78.9 (62.2-89.9) | 83.6 (67.2-97.2) | 4.7% increase (0.69) |
| Positive predictive value | 86.9 (75.2-93.8) | 90.6 (79.5-98.7) | 3.7% increase (0.65) |
| Negative predictive value | 71.4 (55.2-83.8) | 68.8 (50.6-82.1) | 2.6% decrease (0.83) |
| Prevalence advanced fibrosis | 42.7 (33.1-52.8) | 50.2 (37.1-65.2) | 7.5% increase (0.37) |
| Biopsy stage METAVIR ≥ F3 | |||
| Sensitivity | 100 | 85.2 (64.6-99.8) | 14.8% decrease (NA) |
| Specificity | 100 | 100 (100-100) | NA (NA) |
| Positive predictive value | 100 | 100 (100-100) | NA (NA) |
| Negative predictive value | 100 | 87.0 (63.7-99.9) | 13% decrease (NA) |
| FibroTest with cutoff of > 0.58 | |||
| Sensitivity | 70.5 (54.6-82.8) | 66.1 (51.2-80.1) | 4.4% decrease (0.69) |
| Specificity | 83.1 (70.6-91.1) | 86.4 (74.2-96.3) | 3.3% increase (0.71) |
| Positive predictive value | 75.6 (59.4-87.1) | 83.3 (66.6-95.9) | 7.7% increase (0.52) |
| Negative predictive value | 79.0 (66.5-87.9) | 71.9 (53.2-85.2) | 7.1% decrease (0.54) |
| FIB-4 with cutoff of ≥ 2.67 | |||
| Sensitivity | 38.6 (24.7-54.5) | 38.2 (25.0-52.3) | 0.4% decrease (0.97) |
| Specificity | 88.1 (76.5-94.7) | 91.7 (79.9-99.5) | 3.6% increase (0.67) |
| Positive predictive value | 70.8 (48.8-86.6) | 82.4 (56.5-99.2) | 11.6% increase (0.50) |
| Negative predictive value | 65.8 (54.2-75.9) | 59.8 (44.2-72.6) | 6% decrease (0.55) |
| VCTE with LSM cutoff of ≥ 9.5 | |||
| Sensitivity | 84.1 (69.3-92.8) | 84.0 (72.2-92.9) | 0.1% decrease (0.94) |
| Specificity | 72.9 (59.5-83.3) | 81.7 (65.2-98.8) | 8.8% increase (0.42) |
| Positive predictive value | 69.8 (55.5-81.3) | 82.2 (62.4-99.0) | 12.4% increase (0.32) |
| Negative predictive value | 86.0 (72.6-93.7) | 83.5 (69.4-92.9) | 2.5% decrease (0.80) |
Table 4 Comparison of the diagnostic performance of biopsy, ActiTest, and alanine aminotransferase for advanced activity (A2 and A3) with the gold standard model and Bayesian latent class model
| Parameters and cutoffs | Biopsy assumed as perfect reference | Bayesian LCM | Gold standard model vs LCM |
| Number of patients | 103 | 103 | Difference (Z-test P-value) |
| Prevalence advanced activity | 61.2 (51.0-70.5) | 47.8 (37.7-58.3) | 13.4% decrease (0.07) |
| Biopsy stage METAVIR ≥ A2 | |||
| Sensitivity | 100 | 95.8 (87.5-99.6) | 4.2% decrease (NA) |
| Specificity | 100 | 70.9 (57.4-82.3) | 29.1% decrease (NA) |
| Positive predictive value | 100 | 75.1 (62.7-85.6) | 24.9% decrease (NA) |
| Negative predictive value | 100 | 94.8 (84.5-99.5) | 5.2% decrease (NA) |
| ActiTest with cutoff of > 0.52 | |||
| Sensitivity | 73.0 (60.1-83.1) | 97.3 (85.8-100) | 24.3% increase (0.006) |
| Specificity | 95.0 (81.8-99.1) | 99.4 (93.4-100) | 4.4% increase (0.59) |
| Positive predictive value | 95.8 (84.6-99.3) | 99.3 (92.6-100) | 3.5% increase (0.60) |
| Negative predictive value | 69.1 (55.0-80.5) | 97.7 (86.6-100) | 28.6% increase (0.002) |
| ALT with cutoff of ≥ 50 | |||
| Sensitivity | 81.0 (68.7-89.4) | 99.5 (95.0-100) | 18.5% increase (0.006) |
| Specificity | 70.0 (53.3-82.9) | 74.3 (61.6-85.7) | 4.2% increase (0.69) |
| Positive predictive value | 81.0 (68.7-89.4) | 78.0 (65.8-88.4) | 3.0% decrease (0.73) |
| Negative predictive value | 70.0 (53.3-82.9) | 99.4 (94.0-100) | 29.4% increase (0.006) |
- Citation: Peta V, Sandler Y, Deckmyn O, Duroselle O, Vinnitskaya E, Khomeriki S, Noskova K, Poynard T. Diagnostic performance of FibroTest-ActiTest, transient elastography, and the fibrosis-4 index in patients with autoimmune hepatitis using histological reference. World J Hepatol 2025; 17(3): 104534
- URL: https://www.wjgnet.com/1948-5182/full/v17/i3/104534.htm
- DOI: https://dx.doi.org/10.4254/wjh.v17.i3.104534