Roger Chou, MD; Ngoc Wasson, MPH
Disclaimer: The findings and conclusions in this article are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Tracy Dana, MLS; AHRQ Task Order Officer Christine Chang, MD, MPH; and USPSTF Medical Officer Iris Mabry-Hernandez, MD, MPH.
Grant Support: By AHRQ (contract 290-2007-10057-I, task order 8), Rockville, Maryland.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-3007.
Requests for Single Reprints: Roger Chou, MD, Oregon Health & Science University, Mail Code BICC, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098; e-mail, email@example.com.
Current Author Addresses: Drs. Chou and Wasson: Oregon Health & Science University, Mail Code BICC, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098.
Author Contributions: Conception and design: R. Chou.
Analysis and interpretation of the data: R. Chou.
Drafting of the article: R. Chou.
Critical revision of the article for important intellectual content: R. Chou.
Final approval of the article: R. Chou.
Provision of study materials or patients: R. Chou.
Statistical expertise: R. Chou.
Obtaining of funding: R. Chou.
Administrative, technical, or logistic support: R. Chou, N. Wasson.
Collection and assembly of data: R. Chou, N. Wasson.
Chou R, Wasson N. Blood Tests to Diagnose Fibrosis or Cirrhosis in Patients With Chronic Hepatitis C Virus Infection: A Systematic Review. Ann Intern Med. 2013;158:807-820. doi: 10.7326/0003-4819-158-11-201306040-00005
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Published: Ann Intern Med. 2013;158(11):807-820.
This article has been corrected. The original version (PDF) is appended to this article as a supplement.
Many blood tests have been proposed as alternatives to liver biopsy for identifying fibrosis or cirrhosis.
To evaluate the diagnostic accuracy of blood tests to identify fibrosis or cirrhosis in patients with hepatitis C virus (HCV) infection.
MEDLINE (1947 to January 2013), the Cochrane Library, and reference lists.
Studies that compared the diagnostic accuracy of blood tests with that of liver biopsy.
Investigators abstracted and checked study details and quality by using predefined criteria.
172 studies evaluated diagnostic accuracy. For identifying clinically significant fibrosis, the platelet count, age–platelet index, aspartate aminotransferase–platelet ratio index (APRI), FibroIndex, FibroTest, and Forns index had median positive likelihood ratios of 5 to 10 at commonly used cutoffs and areas under the receiver-operating characteristic curve (AUROCs) of 0.70 or greater (range, 0.71 to 0.86). For identifying cirrhosis, the platelet count, age–platelet index, APRI, and Hepascore had median positive likelihood ratios of 5 to 10 and AUROCs of 0.80 or greater (range, 0.80 to 0.91). The Göteborg University Cirrhosis Index and the Lok index had slightly lower positive likelihood ratios (4.8 and 4.4, respectively). In direct comparisons, the APRI was associated with a slightly lower AUROC than the FibroTest for identifying fibrosis and a substantially higher AUROC than the aspartate aminotransferase–alanine aminotransferase ratio for identifying fibrosis or cirrhosis.
Only English-language articles were included, and most studies had methodological limitations, including failure to describe blinded interpretation of liver biopsy specimens and inadequate description of enrollment methods.
Many blood tests are moderately useful for identifying clinically significant fibrosis or cirrhosis in HCV-infected patients.
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Gastroenterology/Hepatology, Infectious Disease, Viral Hepatitis, Liver Disease.
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