Optimized stepwise combination algorithms of non-invasive liver fibrosis scores including Hepascore in hepatitis C virus patients

Aliment Pharmacol Ther. 2008 Aug 15;28(4):458-67. doi: 10.1111/j.1365-2036.2008.03742.x. Epub 2008 May 22.


Background: Non-invasive liver fibrosis scores such as Hepascore (HS) have been proposed as an alternative to liver biopsy in hepatitis C virus (HCV)-infected patients.

Aim: To validate HS as an alternative to liver biopsy and Fibrotest (FT) and propose five optimized combination algorithms to improve diagnostic accuracy.

Methods: The cohort included 467 patients with HCV. There were 274/467 (59%) men, and mean age was 47 +/- 12 years.

Results: Hepascore area under ROC curves (AUC) for > or =F2, F3F4 and F4 diagnosis were 0.82, 0.84 and 0.90 respectively, in the same range as FT. HS and FT were concordant in 387/467 (82%) for fibrosis staging. Among these patients, 342/387 (88%) were concordant with liver biopsy. AUCs of aspartate aminotransferase (AST) to Platelets Ratio Index (APRI) and Forns for > or =F2 were 0.76 and 0.73 (0.65-0.79) respectively. The algorithm combining APRI and HS had the highest rate of avoided liver biopsies (45%) with a high diagnostic accuracy (91%).

Conclusions: Hepascore is an accurate non-invasive marker for > or =F2 and F4 diagnosis in HCV patients. In a pragmatic approach, a stepwise optimized algorithm combining APRI and FT or HS considerably increases diagnostic accuracy and avoided liver biopsies.

Publication types

  • Multicenter Study
  • Validation Study

MeSH terms

  • Algorithms
  • Biomarkers / blood*
  • Biopsy
  • Cohort Studies
  • Cross-Sectional Studies
  • Disease Progression
  • Female
  • Hepatitis C, Chronic*
  • Humans
  • Liver / pathology*
  • Liver Cirrhosis / diagnosis*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • ROC Curve
  • Treatment Outcome
  • Viral Load


  • Biomarkers