Non-invasive algorithm for detecting advanced liver fibrosis in chronic hepatitis B patients.

Chronic hepatitis B is the most important cause of liver cirrhosis in Asia. Liver fibrosis is the intermediate stage to liver cirrhosis. Determining severity of liver fibrosis is important to determine the prognosis, risk of hepatocellular carcinoma, and need for antiviral therapy. Liver biopsy is the gold standard, but it is limited by its invasiveness and risk of bleeding. Transient elastography by the Fibroscan is a non-invasive measure for severity of liver fibrosis. Liver stiffness is measured based on shear wave velocity across the liver. It is accurate to determine advanced fibrosis in chronic hepatitis B and C patients, but the accuracy for mild-tomoderate fibrosis is less optimal.1 Various serum indices are developed to measure liver fibrosis in viral hepatitis, including aspartate aminotransferase– to-platelet ratio-index, Forns index, FIB-4, Hui index, and Fibroindex. We investigated a combined algorithm of a serum test formula with Fibroscan for the evaluation of severity of liver fibrosis in chronic hepatitis B patients. A biopsy cohort of 156 hepatitis B patients was used as the training cohort,2 and the resultant algorithm was validated in an independent cohort of 82 patients with liver biopsy. Liver stiffness measurement by Fibroscan was superior to that by all other serum test formulae, consistent in both the training and the validation cohorts.3 The area under the receiver operating characteristics curve (AUROC) for Fibroscan was 0.88 (95% confidence interval [CI], 0.85-0.91, P<0.001) in the training cohort and 0.80 (95% CI, 0.68-0.92, P<0.001) in the validation cohort. Among various serum tests formulae, Forns index was best in diagnosing advanced fibrosis, with an AUROC of 0.70 (95% CI, 0.62-0.78, P<0.001) in the training cohort and 0.72 (95% CI, 0.60-0.85, P<0.001) in the validation cohort. By combining the liver stiffness measurement and Forns index, an algorithm superior to either test was derived. A low liver stiffness or a Forns index of <5.2 could exclude >60% patients with mild fibrosis Hong Kong Med J 2014;20(Suppl 6):S31 RFCID project number: 09080292 HLY Chan *, VWS Wong, GLH Wong, PCL Choi