Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection.

Data Synthesis: 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.