Blood Tests to Diagnose Fibrosis or Cirrhosis in Patients With Chronic Hepatitis C Virus Infection

作者：Roger Chou, Ngoc Wasson · 发表于：Annals of Internal Medicine · 年份：2013 · DOI：10.7326/0003-4819-158-11-201306040-00005 · 被引用次数：369 · 研究领域：Liver Disease Diagnosis and Treatment、Hepatitis C virus research、Liver Disease and Transplantation

BACKGROUND: Many blood tests have been proposed as alternatives to liver biopsy for identifying fibrosis or cirrhosis. PURPOSE: To evaluate the diagnostic accuracy of blood tests to identify fibrosis or cirrhosis in patients with hepatitis C virus (HCV) infection. DATA SOURCES: MEDLINE (1947 to January 2013), the Cochrane Library, and reference lists. STUDY SELECTION: Studies that compared the diagnostic accuracy of blood tests with that of liver biopsy. DATA EXTRACTION: Investigators abstracted and checked study details and quality by using predefined criteria. 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 aminotrans...