Comparison of test performance profile for blood tests of liver fibrosis in chronic hepatitis C

Background/Aims We evaluated the test performance profile (TPP) of blood tests of liver fibrosis. Methods Three hundred and fifty-six patients with C chronic hepatitis were included in two centers. Metavir staging of liver specimens by two independent pathologists and the following tests were evaluated: Fibrotest (FT), APRI, FibroMeter (FM), and Hepascore (HS). Results Metavir stages were: F0: 4%, F1: 55%, F2: 26%, F3: 11%, and F4: 4%. The AUROCs were not significantly different, respectively, FT, FM, APRI, HS: F2: 0.79, 0.78, 0.76, 0.76; F3: 0.81, 0.85, 0.81, 0.81; and F4: 0.86, 0.94, 0.92, 0.89. The TPP relies on the paired comparison of blood-test misclassification based on liver specimen, e.g. FT vs FM, respectively: F0+1: 18 vs 28% (p = 0.0003), F2: 43 vs 31% (p = 0.004). There was no center effect. Conclusions In those populations, the four blood tests had a similar performance for significant fibrosis (F 2), lying in the lower range of published results which is attributable to a low F2 prevalence, and for F3 and F4. However, FM and FT had performance profiles significantly different as a function of fibrosis stages or diagnostic target (fibrosis cut-off). This has to be considered during the interpretation process. Moreover, the performance should be reported with different diagnostic targets.