Comparison of non-invasive assessment to diagnose liver fibrosis in chronic hepatitis B and C patients

Scand J Gastroenterol. 2011 Jul;46(7-8):962-72. doi: 10.3109/00365521.2011.574725. Epub 2011 May 30.


Objective: Chronic viral hepatitis B and C cause liver fibrosis, leading to cirrhosis. Fibrosis assessment is essential to establish prognosis and treatment indication. We compared seven non-invasive tests, separately and in combination, in chronic hepatitis patients to detect early stages of fibrosis according to the Metavir score in liver biopsy.

Material and methods: Galactose and methacetin breath tests (GBT and MBT), biomarkers (hyaluronic acid (HA), aspartate aminotransferase platelet ratio index (APRI), FibroTest, and Fib-4) and transient elastography (TE) were evaluated in 89 patients. Additionally, 31 healthy controls were included for evaluation of breath tests and biomarkers.

Results: Serum markers (HA, APRI, FibroTest, and Fib-4) and elastography significantly distinguished non-cirrhotic (F0123) from cirrhotic (F4) patients (p < 0.001, p = 0.015, p < 0.001, p = 0.005, p = 0.006, respectively). GBT, HA, APRI, FibroTest, Fib-4, and TE detected F01 from F234 (p = 0.04, p = 0.011, p = 0.009, p < 0.001, p < 0.001, and p < 0.001, respectively). A combination of different tests (TE, HA, and FibroTest) improved the performance statistically, area under the curve (AUC) = 0.87 for F234, 0.92 for F34, and 0.90 for F4.

Conclusion: HA, APRI, FibroTest, Fib-4, and TE reliably distinguish non-cirrhotic and cirrhotic patients. Except for MBT, all tests discriminate between mild and moderate fibrosis. As single tests: FibroTest, Fib-4, and TE were the most accurate for detecting early fibrosis; combining different non-invasive tests increased the accuracy for detection of liver fibrosis to such an extent and thus might be acceptable to replace liver biopsy.

Publication types

  • Comparative Study

MeSH terms

  • Acetamides / analysis
  • Adult
  • Aspartate Aminotransferases / blood
  • Biomarkers / analysis
  • Biomarkers / blood
  • Blood Platelets
  • Breath Tests
  • Elasticity Imaging Techniques
  • False Negative Reactions
  • False Positive Reactions
  • Female
  • Galactose / analysis
  • Hepatitis B, Chronic / complications*
  • Hepatitis B, Chronic / pathology
  • Hepatitis C, Chronic / complications*
  • Hepatitis C, Chronic / pathology
  • Humans
  • Hyaluronic Acid / blood
  • Linear Models
  • Liver / pathology
  • Liver Cirrhosis / diagnosis*
  • Liver Cirrhosis / etiology*
  • Male
  • Middle Aged
  • ROC Curve


  • Acetamides
  • Biomarkers
  • methacetin
  • Hyaluronic Acid
  • Aspartate Aminotransferases
  • Galactose