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

Performance of serum marker panels for liver fibrosis in chronic hepatitis C
Performance of serum marker panels for liver fibrosis in chronic hepatitis C
Background/Aims: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
0168-8278
462-474
Parkes, J.
59dc6de3-4018-415e-bb99-13552f97e984
Guha, I.N.
15ece18d-5a89-4c6d-9c85-9df96dd022e1
Roderick, P.
b4dd8e43-2f6c-4306-a422-423d9fe273c4
Rosenberg, W.M.
8558a866-4b74-4f3f-9802-774a8a82d82a
Parkes, J.
59dc6de3-4018-415e-bb99-13552f97e984
Guha, I.N.
15ece18d-5a89-4c6d-9c85-9df96dd022e1
Roderick, P.
b4dd8e43-2f6c-4306-a422-423d9fe273c4
Rosenberg, W.M.
8558a866-4b74-4f3f-9802-774a8a82d82a

Parkes, J., Guha, I.N., Roderick, P. and Rosenberg, W.M. (2006) Performance of serum marker panels for liver fibrosis in chronic hepatitis C. Journal of Hepatology, 44 (3), 462-474. (doi:10.1016/j.jhep.2005.10.019).

Record type: Article

Abstract

Background/Aims: 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.
Methods: 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.
Results: 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.
Conclusions: 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.

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Published date: 2006

Identifiers

Local EPrints ID: 27312
URI: http://eprints.soton.ac.uk/id/eprint/27312
ISSN: 0168-8278
PURE UUID: f675648f-4993-4c26-ac7e-76a9209f3eee
ORCID for J. Parkes: ORCID iD orcid.org/0000-0002-6490-395X

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Date deposited: 25 Apr 2006
Last modified: 16 Mar 2024 03:02

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Author: J. Parkes ORCID iD
Author: I.N. Guha
Author: P. Roderick
Author: W.M. Rosenberg

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