Open Access Research article

FibroSURE as a noninvasive marker of liver fibrosis and inflammation in chronic hepatitis B

Marija Zeremski1*, Rositsa B Dimova2, Samantha Benjamin1, Jessy Makeyeva1, Rhonda K Yantiss3, Maya Gambarin-Gelwan14 and Andrew H Talal15

Author Affiliations

1 Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA

2 Department of Biostatistics, State University of New York at Buffalo, Buffalo, NY, USA

3 Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA

4 Gastroenterology and Nutrition Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

5 Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, State University of New York at Buffalo, Buffalo, NY, USA

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BMC Gastroenterology 2014, 14:118  doi:10.1186/1471-230X-14-118

Published: 3 July 2014



Noninvasive markers of liver fibrosis have not been extensively studied in patients with chronic hepatitis B virus (HBV) infection. Our aim was to evaluate the capacity of FibroSURE, one of the two noninvasive fibrosis indices commercially available in the United States, to identify HBV infected patients with moderate to severe fibrosis.


Forty-five patients who underwent liver biopsy at a single tertiary care center were prospectively enrolled and had FibroSURE performed within an average interval of 11 days of the biopsy.


Of the 45 patients, 40% were Asian, 40% were African American, and 13% were Caucasian; 27% were co-infected with HIV and 67% had no or mild fibrosis. We found FibroSURE to have moderate capacity to discriminate between patients with moderate to high fibrosis and those with no to mild fibrosis (area under receiver operating characteristic [AUROC] curve = 0.77; 95% confidence interval [CI] [0.61, 0.92]). When we combined the fibrosis score determined by FibroSURE with aspartate aminotransferase (AST) measurements and HIV co-infection status, the discriminatory ability significantly improved reaching an AUROC of 0.90 (95% CI [0.80, 1.00]). FibroSURE also had a good ability to differentiate patients with no or mild from those with moderate to high inflammation (AUROC = 0.83; 95% CI [0.71, 0.95]).


FibroSURE in combination with AST levels has an excellent capacity to identify moderate to high fibrosis stages in chronic HBV-infected patients. These data suggest that FibroSURE may be a useful substitute for liver biopsy in chronic HBV infection.

Hepatitis B virus; Liver biopsy replacement; Liver fibrosis assessment; Liver histology