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Abstract
Noninvasive biomarkers have been developed to predict hepatitis B virus (HBV)-related fibrosis owing to the significant limitations of liver biopsy. Those biomarkers were initially derived from evaluation of hepatitis C virus (HCV)-related fibrosis, and their accuracy among HBV-infected patients was under constant debate. A systematic review was conducted on records in PubMed, EMBASE and the Cochrane Library electronic databases, up until April 1st, 2013, in order to systematically assess the effectiveness and accuracy of these biomarkers for predicting HBV-related fibrosis. The questionnaire for quality assessment of diagnostic accuracy studies (QUADAS) was used. Out of 115 articles evaluated for eligibility, 79 studies satisfied the pre-determined inclusion criteria for meta-analysis. Eventually, our final data set for the meta-analysis contained 30 studies. The areas under the SROC curve for APRI, FIB-4, and FibroTest of significant fibrosis were 0.77, 0.75, and 0.84, respectively. For cirrhosis, the areas under the SROC curve for APRI, FIB-4 and FibroTest were 0.75, 0.87, and 0.90, respectively. The heterogeneity of FIB-4 and FibroTest were not statistically significant. The heterogeneity of APRI for detecting significant fibrosis was affected by median age (P = 0.0211), and for cirrhosis was affected by etiology (P = 0.0159). Based on the analysis we claim that FibroTest has excellent diagnostic accuracy for identification of HBV-related significant fibrosis and cirrhosis. FIB-4 has modest benefits and may be suitable for wider scope implementation.
Highlights
Chronic infection with hepatitis B virus (HBV) is an important global health problem
Online database search was completed on PubMed, EMBASE and the Cochrane Library (01/2003-04/ 2013) for terms including the following: aspartate aminotransferase-to-platelet ratio index, APRI, fibrosis index based on the 4 factors, FIB-4, FibroTest, hepatitis B virus, HBV, Chronic hepatitis B, CHB, fibrosis and cirrhosis
Special populations of HBV patients (e.g., HBV/human immunodeficiency virus (HIV) coinfection, HBV/hepatitis C virus (HCV), and HBV/ hepatitis D virus [HDV]) were included. (b) Liver biopsy was used to diagnose liver fibrosis as a golden standard. (c) Data could be extracted to construct at least one 262 table of test performance, based on some cutoff points of the APRI, FIB-4, and FibroTest for a fibrosis stage. (d) They assessed the diagnostic accuracy for fibrosis stage F$2 or F$4 according to METAVIR or a comparable staging system. (e) The study included at least 40 patients
Summary
Chronic infection with hepatitis B virus (HBV) is an important global health problem. 350 million people are chronically infected with hepatitis B virus worldwide, especially in developing countries, 25% of whom will die from long term sequelae, such as cirrhosis, liver failure and hepatocellular carcinoma, resulting in 600,000 to one million deaths annually [1]. Assessment of liver significant fibrosis is critical to establishing effective clinical practice. It could be of great help for a doctor to determine patients’ suitability and the optimal time for antiviral therapy to achieve the best curative effects as well as to prevent excessive medication [3]. Early prediction of cirrhosis is beneficial to reducing complications in patients with chronic viral hepatitis [4]
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