BioLiveScale: FibroMeters, blood tests used for the diagnosis of liver fibrosis (HBV or HCV, alcohol, metabolic steatopathy)

1.1 HBV

In the pivotal study, the FibroMeter AUROC was 0.868 in HBV patients versus 0.883 in HCV patients (2). In an independent study including 255 HBV patients and 255 HCV patients, FibroMeter AUROC was the highest among 4 blood tests and not significantly different from that observed in HCV patients (26).

1.2 Co-infection

FibroMeter has been compared to other blood tests in a large series of 272 HCV-HIV co-infected patients (27). Fibrometer AUROC was the highest among 7 blood tests. We have tested several blood tests in a large cohort of 452 HCV-HIV co-infected patients including the previous cohort. We have implemented a specific FibroMeter for co-infection with an AUROC 0.83 for significant fibrosis (28).

2.1 Alcohol

Fibrometer for ALD had a high diagnostic performance in the pivotal study with AUROC: 0.962 for significant fibrosis (2) which was confirmed in a meta-analysis (29). However, this excellent performance is partially due to the high prevalence of severe fibrosis in ALD with liver biopsy.

2.2 NAFLD

FibroMeter specific for NAFLD includes glucose, AST, ferritin, platelet, ALT, body weight and age. Thus, the FibroMeter NAFLD includes three markers specific of the metabolic syndrome. It has been evaluated in 235 NAFLD patients (30). The highest accuracy - 91% - for significant fibrosis was obtained with the FibroMeter NAFLD whose AUROC (0.943) was significantly higher than those of NAFLD fibrosis score (31) (0.884, p=0.008 vs FibroMeter) and APRI (0.866, p<10-3 vs FibroMeter; p=0.309 vs NFSA). By using thresholds of 90% predictive values (accepted error: 10%), liver biopsy could have been avoided in most patients: FibroMeter: 97.4% compared to NAFLD fibrosis score: 86.8% (p<10-3) and APRI: 80.0% (p<10-3). The new classification of patients, based on interval of reliable diagnosis, provided three reliable diagnosis intervals: F0/1, F2+/-1, F3+/-1 with 91.4% accuracy for FibroMeter NAFLD, avoiding biopsy in all patients.

FibroMeter virus has been validated in hemophiliacs (32) and in African HBV patients (33)

1. Oberti F, Valsesia E, Pilette C, Rousselet MC, Bedossa P, Aube C, et al. Noninvasive diagnosis of hepatic fibrosis or cirrhosis. Gastroenterology 1997;113:1609-16.
2. Cales P, Oberti F, Michalak S, Hubert-Fouchard I, Rousselet MC, Konate A, et al. A novel panel of blood markers to assess the degree of liver fibrosis. Hepatology 2005;42:1373-81.
3. Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. The French METAVIR Cooperative Study Group. Hepatology 1994;20:15-20.
4. Pilette C, Rousselet MC, Bedossa P, Chappard D, Oberti F, Rifflet H, et al. Histopathological evaluation of liver fibrosis: quantitative image analysis vs semi-quantitative scores. Comparison with serum markers. J Hepatol 1998;28:439-46.
5. Imbert-Bismut F, Ratziu V, Pieroni L, Charlotte F, Benhamou Y, Poynard T. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet 2001;357:1069-75.
6. Forns X, Ampurdanes S, Llovet JM, Aponte J, Quinto L, Martinez-Bauer E, et al. Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model. Hepatology 2002;36:986-92.
7. Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003;38:518-26.
8. Patel K, Gordon SC, Jacobson I, Hezode C, Oh E, Smith KM, et al. Evaluation of a panel of non-invasive serum markers to differentiate mild from moderate-to-advanced liver fibrosis in chronic hepatitis C patients. J Hepatol 2004;41:935-42.
9. Rosenberg WM, Voelker M, Thiel R, Becka M, Burt A, Schuppan D, et al. Serum markers detect the presence of liver fibrosis: a cohort study. Gastroenterology 2004;127:1704-13.
10. Halfon P, Bacq Y, De Muret A, Penaranda G, Bourliere M, Ouzan D, et al. Comparison of test performance profile for blood tests of liver fibrosis in chronic hepatitis C. J Hepatol 2007;46:395-402.
11. Leroy V, Hilleret MN, Sturm N, Trocme C, Renversez JC, Faure P, et al. Prospective comparison of six non-invasive scores for the diagnosis of liver fibrosis in chronic hepatitis C. J Hepatol 2007;46:775-82.
12. Calès P, de Ledinghen V, Halfon P, Bacq Y, Leroy V, Boursier J, et al. Evaluating accuracy and increasing the reliable diagnosis rate of blood tests for liver fibrosis in chronic hepatitis C. Liver International 2008;(in press).
13. Adams LA, Bulsara M, Rossi E, DeBoer B, Speers D, George J, et al. Hepascore: an accurate validated predictor of liver fibrosis in chronic hepatitis C infection. Clin Chem 2005;51:1867-1873.
14. Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology 2007;46:32-6.
15. Rousselet MC, Michalak S, Dupre F, Croue A, Bedossa P, Saint-Andre JP, et al. Sources of variability in histological scoring of chronic viral hepatitis. Hepatology 2005;41:257-64.
16. Colletta C, Smirne C, Fabris C, Toniutto P, Rapetti R, Minisini R, et al. Value of two noninvasive methods to detect progression of fibrosis among HCV carriers with normal aminotransferases. Hepatology 2005;42:838-45.
17. Leroy V, Halfon P, Bacq Y, Boursier J, Rousselet M, Bourlière M, et al. Diagnostic accuracy, reproducibility and robustness of fibrosis blood tests in chronic hepatitis C: a meta-analysis with individual data. Clin Biochem 2008;(in press).
18. Cales P, Veillon P, Konate A, Mathieu E, Ternisien C, Chevailler A, et al. Reproducibility of blood tests of liver fibrosis in clinical practice. Clin Biochem 2008;41:10-8.
19. Calès P, Boursier J, Rousselet M, Michalak S, Oberti F, Gallois Y, et al. Comparison of reproducibility of histology, blood tests and Fibroscan for liver fibrosis. Hepatology 2007;46:834A.
20. Poynard T, Imbert-Bismut F, Munteanu M, Messous D, Myers RP, Thabut D, et al. Overview of the diagnostic value of biochemical markers of liver fibrosis (FibroTest, HCV FibroSure) and necrosis (ActiTest) in patients with chronic hepatitis C. Comp Hepatol 2004;3:8.
21. Boursier J, Bacq Y, Halfon P, Leroy V, de Ledinghen V, de Muret A, et al. Improved diagnostic accuracy of blood tests for severe fibrosis and cirrhosis in chronic hepatitis C. Eur J Gastroenterol Hepatol 2008;(in press).
22. Boursier J, de Ledinghen V, Sawadogo A, Lebigot J, Michalak S, Gallois Y, et al. Amélioration du diagnostic de la fibrose hépatique par la combinaison synchrone de tests non invasifs (résumé). Gastroenterol Clin Biol 2007;31:31.
23. Boursier J, Dib N, Oberti F, Cales P. [Characteristics and interpretation of blood tests for liver fibrosis]. Gastroenterol Clin Biol 2007;31:511-23.
24. Boursier J, Dib N, Oberti F, Hubert I, Rousselet M, Gallois Y, et al. Role of fibrosis degree in the clinical course of chronic liver diseases. Gastroenterology 2007;132:A804.
25. Pinzani M, Vizzutti F, Arena U, Marra F. Technology Insight: noninvasive assessment of liver fibrosis by biochemical scores and elastography. Nat Clin Pract Gastroenterol Hepatol 2008;5:95-106.
26. Leroy V, Sturm N, Hilleret M, Renversez P, Trocmé C, Faure P, et al. Diagnostic accuracy of blood tests of liver fibrosis in chronic hepatitis B: comparison with hepatitis C (abstract). Hepatology 2007;46:900-1A.
27. Cacoub P, Carrat F, Bedossa P, Lambert J, Penaranda G, Perronne C, et al. Comparison of non-invasive liver fibrosis biomarkers in HIV/HCV co-infected patients: The fibrovic study - ANRS HC02. J Hepatol 2008;48:765-73.
28. Calès P, Halfon P, Batisse D, Carrat F, Perré P, Penaranda G, et al. Tests sanguins de fibrose hépatique chez les patients co-infectés VIH et VHC. Gastroenterol Clin Biol 2008;(in press).
29. Oberti F, Anty R, Vanbiervliet G, Lacave-Oberti N, Gelsi E, Rosenthal A, et al. Meta-analysis of blood scores of liver fibrosis (Fibrometer, Hepascore, APRI) in alcoholic chronic liver diseases (abstract). Hepatology 2006;44:467A.
30. Calès P, Lainé F, Boursier J, Deugnier Y, Moal V, Oberti F, et al. Comparison of blood tests for liver fibrosis specific or not to NAFLD. J Hepatol 2008;(in press).
31. Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology 2007;45:846-54.
32. Maor Y, Cales P, Bashari D, Kenet G, Lubetsky A, Luboshitz J, et al. Improving estimation of liver fibrosis using combination and newer noninvasive biomarker scoring systems in hepatitis C-infected haemophilia patients. Haemophilia 2007;13:722-9.
33. Sombié R, Lescure F, Bougouma A, Guiard-Schmid J, Poynard T, Calès P, et al. Evaluation de la fibrose hépatique (histologie, marqueurs sériques, élastométrie) chez des patients infectés par le VHB au Burkina Faso. JAHG 2007:(in press).
34. Foucher J, Chanteloup E, Vergniol J, Castera L, Le Bail B, Adhoute X, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut 2006;55:403-8.

1 Other virus

2 Other causes

3 Particular settings

References

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