FIB-4: An inexpensive and accurate marker of fibrosis in... : Hepatology (original) (raw)

Original Articles

An inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest

Vallet-Pichard, Anaïs1,2,3; Mallet, Vincent1,2,3; Nalpas, Bertrand1,2,3; Verkarre, Virginie4; Nalpas, Antoine3; Dhalluin-Venier, Valérie1,3; Fontaine, Hélène1,2,3; Pol, Stanislas1,2,3,*

1_Université Paris-Descartes, Paris, France_

2_INSERM Unité 567, Paris, France_

3_Assistance Publique Hŏpitaux de Paris, Hŏpital Cochin, Unité d'hépatologie, Paris, France_

4_Assistance Publique Hŏpitaux de Paris, Hŏpital Necker Enfants Malades, Anatomopathologie, Paris, France_

*Address reprint requests to: Unité d'hépatologie, Hŏpital Cochin, 27 rue du faubourg Saint Jacques, 75014 Paris, France

Email: [email protected]

Received 9 October 2006; Accepted 9 January 2007

Published online in Wiley InterScience (www.interscience.wiley.com).

Potential conflict of interest: Nothing to report.

fax: (33)1-58-41-30-15

Abstract

To optimize the management of patients with chronic hepatitis C virus (HCV) infection, noninvasive tests to determine the degree of hepatic fibrosis have been developed. The aims of this study were (1) to validate a simple, inexpensive, noninvasive test called FIB-4, which combines standard biochemical values (platelets, ALT, AST) and age, in a series of 847 liver biopsies performed in HCV-monoinfected patients; and (2) to compare the results of 780 FIB-4 and FibroTests performed the same day in a series of 592 HCV-infected patients. The FIB-4 index enabled the correct identification of patients with severe fibrosis (F3-F4) and cirrhosis with an area under the receiver operating characteristic curve of 0.85 (95% CI 0.82-0.89) and 0.91 (95% CI 0.86-0.93), respectively. An FIB-4 index <1.45 had a negative predictive value of 94.7% to exclude severe fibrosis with a sensitivity of 74.3%. An FIB-4 index higher than 3.25 had a positive predictive value to confirm the existence of a significant fibrosis (F3-F4) of 82.1% with a specificity of 98.2%. Using these ranges, 72.8% of the 847 liver biopsies were correctly classified. The FIB-4 index was strongly correlated to the FibroTest results for a score <1.45 or >3.25 (κ = 0.561, P < 0.01). A FIB-4 value <1.45 or >3.25 (64.6% of the cases) was concordant with FibroTest results in 92.1% and 76%, respectively. Conclusion: For values outside 1.45-3.25, the FIB-4 index is a simple, accurate, and inexpensive method for assessing liver fibrosis and proved to be concordant with FibroTest results. (HEPATOLOGY 2007.)

Abbreviations: APRI, AST-to-platelet ratio index; LB, liver biopsy; ROC, receiver operating characteristic.