Comparison of Surrogate Serum Markers and Transient Elastography (Fibroscan) for Assessing Cirrhosis in Patients with Chronic Viral Hepatitis

Abstract

Progressive hepatic fibrosis with development of cirrhosis is a feature of almost all chronic liver diseases. We assessed the performance of Fibroscan in patients with chronic viral hepatitis, and in comparison with and combined with several surrogate serum markers for predicting cirrhosis. In this prospective multicenter cohort study, a novel panel of serum markers was constructed and serum levels of surrogate markers of liver fibrosis and Fibroscan were compared with the stage of fibrosis in the liver biopsy specimens obtained from 121 subjects with chronic viral hepatitis. Another 159 patients were enrolled to validate the diagnostic accuracy of this novel panel. Multivariate analysis identified platelet count and procollagen III N-terminal peptide (PIIINP) as independent predictors of liver cirrhosis. The PP score (combining of platelet count and PIIINP) showed significantly better diagnostic accuracy (areas under the receiver operating characteristic curves, AUROC: 0.885) than that of previously reported serologic tests, including APRI, Forns fibrosis index, FIB-4 index and ELF algorithm, in the validation group (AUROC: 0.792, 0.740, 0.800, and 0.775, respectively). The AUROC of Fibroscan was 0.743 and the best performance was obtained by combining Fibroscan, platelet count and PIIINP, with an AUROC of 0.826. However, there was no significant difference among the AUROCs of Fibroscan alone, PP score, the combination of Fibroscan and PP score, and previously reported serologic tests in the estimation group. Fibroscan and surrogate serum markers had similar accuracy for predicting cirrhosis, and combining Fibroscan and serum markers did not improve the accuracy.