Research article

Meta-analyses of FibroTest diagnostic value in chronic liver disease

Thierry Poynard¹ , Rachel Morra¹ , Philippe Halfon² , Laurent Castera³ , Vlad Ratziu¹ , Françoise Imbert-Bismut⁴ , Sylvie Naveau⁵ , Dominique Thabut¹ , Didier Lebrec⁶ , Fabien Zoulim⁷ , Marc Bourliere⁸ , Patrice Cacoub⁹ , Djamila Messous⁴ , Mona Munteanu¹⁰ and Victor de Ledinghen³

¹Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, Université Paris VI, CNRS ESA 8067 Paris, France

²Laboratoire Alphabio, Marseille, France

³Service d'Hepato-Gastroenterologie, Hopital Haut Leveque, Pessac, France

⁴Laboratoire de Biochimie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France

⁵Service d'Hépato-Gastroentérologie, Hopital Antoine Beclere, Clamart, France

⁶INSERM, U773, Centre de Recherche Biomedicale Bichat-Beaujon CRB3, Service d'Hépatologie, Hopital Beaujon, Paris, France

⁷INSERM U271, Virology laboratory, University Hospital Center, Lyon, France

⁸Service d'Hepato-Gastroenterologie, Hopital Saint-Joseph, Marseille, France

⁹Service de Medecine Interne, Groupe Hospitalier Pitié-Salpêtrière, Université Paris VI, Paris, France

¹⁰Biopredictive, Paris, France

author email corresponding author email

BMC Gastroenterology 2007, 7:40doi:10.1186/1471-230X-7-40

Published:	15 October 2007

Abstract

Background

FibroTest (FT) is a biomarker of liver fibrosis initially validated in patients with chronic hepatitis C (CHC).

The aim was to test two hypotheses, one, that the FT diagnostic value was similar in the three other frequent fibrotic diseases: chronic hepatitis B (CHB), alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD); and the other, that the FT diagnostic value was similar for intermediate and extreme fibrosis stages.

Methods

The main end points were the FT area under the ROC curves (AUROCs) for the diagnosis of bridging fibrosis (F2F3F4 vs. F0F1), standardized for the spectrum of fibrosis stages, and the comparison of FT AUROCs between adjacent stages. Two meta-analyses were performed: one combining all the published studies (random model), and one of an integrated data base combining individual data. Sensitivity analysis integrated the independency of authors, lenght of biopsy, prospective design, respect of procedures, comorbidities, and duration between biopsy and serum sampling.

Results

A total of 30 studies were included which pooled 6,378 subjects with both FT and biopsy (3,501 HCV, 1,457 HBV, 267 NAFLD, 429 ALD, and 724 mixed). Individual data were analyzed in 3,282 patients. The mean standardized AUROC was 0.84 (95% CI, 0.83–0.86), without differences between causes of liver disease: HCV 0.85 (0.82–0.87), HBV 0.80 (0.77–0.84), NAFLD 0.84 (0.76–0.92), ALD 0.86 (0.80–0.92), mixed 0.85 (0.80–0.93). The AUROC for the diagnosis of the intermediate adjacent stages F2 vs. F1 (0.66; 0.63–0.68, n = 2,055) did not differ from that of the extreme stages F3 vs. F4 (0.69; 0.65–0.72, n = 817) or F1 vs. F0 (0.62; 0.59–0.65, n = 1788).

Conclusion

FibroTest is an effective alternative to biopsy in patients with chronic hepatitis C and B, ALD and NAFLD. The FT diagnostic value is similar for the diagnosis of intermediate and extreme fibrosis stages.