Research article

Diagnostic value of biochemical markers (FibroTest-FibroSURE) for the prediction of liver fibrosis in patients with non-alcoholic fatty liver disease

Vlad Ratziu^1,8 , Julien Massard¹ , Frederic Charlotte² , Djamila Messous³ , Françoise Imbert-Bismut³ , Luninita Bonyhay¹ , Mohamed Tahiri¹ , Mona Munteanu⁴ , Dominique Thabut¹ , Jean François Cadranel⁵ , Brigitte Le Bail⁶ , Victor de Ledinghen⁷ and Thierry Poynard¹ for for the LIDO Study Group and the CYTOL study group⁶

¹Hepato-Gastroenterology, AP-HP Groupe Hospitalier Pitié-Salpêtrière, Paris, France

²Pathology, AP-HP Groupe Hospitalier Pitié-Salpêtrière, Paris, France

³Biochemistry, AP-HP Groupe Hospitalier Pitié-Salpêtrière, Paris, France

⁴Biopredictive, Paris, France

⁵Hepato-Gastroenterology, Hôpital Creil, Creil, France

⁶Pathology, Hôpital Haut Lévèque, Bordeaux, France

⁷Hepato-Gastroenterology, Hôpital Haut Lévèque Bordeaux, France

⁸Members of the LIDO and of the CYTOL Study Groups are listed at the end of the manuscript

author email corresponding author email

BMC Gastroenterology 2006, 6:6doi:10.1186/1471-230X-6-6

Published:	14 February 2006

Abstract

Background

Liver biopsy is considered as the gold standard for assessing non-alcoholic fatty liver disease (NAFLD) histologic lesions. The aim of this study was to determine the diagnostic utility of non-invasive markers of fibrosis, validated in chronic viral hepatitis and alcoholic liver disease (FibroTest, FT), in patients with NAFLD.

Methods

170 patients with suspected NAFLD were prospectively included in a reference center (Group 1), 97 in a multicenter study (Group 2) and 954 blood donors as controls. Fibrosis was assessed on a 5 stage histological scale validated by Kleiner et al from F0 = none, F1 = perisinusoidal or periportal, F2 = perisinusoidal and portal/periportal, F3 = bridging and F4 = cirrhosis. Histology and the biochemical measurements were blinded to any other characteristics. The area under the ROC curves (AUROC), sensitivity (Se), specificity (Sp), positive and negative predictive values (PPV, NPV) were assessed.

Results

In both groups FT has elevated and not different AUROCs for the diagnosis of advanced fibrosis (F2F3F4): 0.86 (95%CI 0.77–0.91) versus 0.75 (95%CI 0.61–0.83; P = 0.10), and for F3F4: 0.92 (95%CI 0.83–0.96) versus 0.81 (95%CI 0.64–0.91; P = 0.12) in Group1 and Group 2 respectively. When the 2 groups were pooled together a FT cutoff of 0.30 had a 90% NPV for advanced fibrosis (Se 77%); a FT cutoff of 0.70 had a 73% PPV for advanced fibrosis (Sp 98%).

Conclusion

In patients with NAFLD, FibroTest, a simple and non-invasive quantitative estimate of liver fibrosis reliably predicts advanced fibrosis.