Journal
JOURNAL OF VIRAL HEPATITIS
Volume 17, Issue 8, Pages 537-545Publisher
WILEY-BLACKWELL
DOI: 10.1111/j.1365-2893.2009.01209.x
Keywords
biomarker; ELF; fibrosis; noninvasive; transient elastography; ultrasound
Funding
- Pfizer UK Ltd. Sandwich, UK
- United Kingdom National Institute of Health Research (NIHR)
- British Medical Research Council
- Hammersmith Hospitals Trust Research Committee
- NIHR Biomedical Research Centre
- Medical Research Council [G0502028, G0200250] Funding Source: researchfish
- MRC [G0502028] Funding Source: UKRI
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Combinations of noninvasive markers may improve discrimination of chronic liver disease severity. The aims of this study were to compare four validated serum and ultrasound-based markers of hepatic disease severity head-to-head with liver biopsy and to assess optimal combinations with consideration of cost. A total of 67 patients with biopsy-proven chronic hepatitis C underwent all four techniques on the same visit [aspartate aminotransferase (AST) to platelet ratio index (APRI); Enhanced Liver Fibrosis (ELF) panel; transient elastography (TE) and ultrasound microbubble hepatic transit times (HTT)]. Markers were combined according to increasing financial cost and ordinal regression used to determine contributions. APRI, ELF, TE and HTT predicted cirrhosis with diagnostic accuracy of 86%, 91%, 90% and 83% respectively. ELF and TE were the most reliable tests with an intra-class correlation of 0.94 each. Either ELF or TE significantly enhanced the prediction of fibrosis stage when combined with APRI, but when combined together, did not improve the model further. Addition of third or fourth markers did not significantly improve prediction of fibrosis. Combination of APRI with either ELF or TE effectively predicts fibrosis stage, but combinations of three or more tests lead to redundancy of information and increased cost.
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