Performance of serum marker panels for liver fibrosis in chronic hepatitis C

Chronic hepatitis C (CHC) is characterised by hepatic fibrosis, used as a proxy measure of prognosis. Liver biopsy is a flawed reference standard and serum markers of fibrosis offer an attractive alternative. A systematic review was conducted to assess the performance of panels of serum markers of h...

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Bibliographic Details
Published in:Journal of hepatology 2006-03, Vol.44 (3), p.462-474
Main Authors: Parkes, Julie, Guha, Indra Neil, Roderick, Paul, Rosenberg, William
Format: Article
Language:English
Subjects:
Biological and medical sciences
Biomarkers - blood
Disease Progression
Gastroenterology. Liver. Pancreas. Abdomen
Hepatitis C, Chronic - blood
Hepatitis C, Chronic - complications
Human viral diseases
Humans
Infectious diseases
Liver Cirrhosis - blood
Liver Cirrhosis - etiology
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Medical sciences
Other diseases. Semiology
Prognosis
Severity of Illness Index
Viral diseases
Viral hepatitis
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Summary:Chronic hepatitis C (CHC) is characterised by hepatic fibrosis, used as a proxy measure of prognosis. Liver biopsy is a flawed reference standard and serum markers of fibrosis offer an attractive alternative. A systematic review was conducted to assess the performance of panels of serum markers of hepatic fibrosis in CHC, incorporating analyses placing markers in a clinical context. 14 studies were included with 10 different panels. Median AUC in validation populations was 0.77 and training populations 0.81. Likelihood ratios (LR) ranged from −LR 0.1 to 0.9, + LR 1.2 to 33.1, diagnostic odds ratios (DOR) were 9.0 (median) with a range of 5 to 27- mostly below values of robust tests. Tests perform with either high sensitivity with low specificity or vice versa. Cut-off levels that gave clinically relevant predictive values for the presence/absence of significant fibrosis were applicable to 35% of the population. Serum markers can rule-in or rule-out fibrosis in up to 35% of patients, but cannot differentiate stages of fibrosis reliably. Improvement of index and reference test in needed including evaluation of clinical outcomes as reference. Improved test reporting is needed to derive LR and DOR as performance indicators.
ISSN:0168-8278
1600-0641
DOI:10.1016/j.jhep.2005.10.019