Routinely evaluated clinical assays and laboratory tests [real test] and fibrosis stages of chronic hepatitis B and C

Turk J Gastroenterol. 2014 Oct;25(5):539-45. doi: 10.5152/tjg.2014.6170.


Background/aims: To provide a new mathematical formula to predict liver fibrosis in patients with chronic viral hepatitis.

Materials and methods: Patients with chronic hepatitis B and C who underwent liver biopsy at different centers were included in this study. Chronic hepatitis B was defined as immunopositivity for the hepatitis B surface antigen for at least 6 months, and chronic hepatitis C was defined as positivity for HCV RNA for at least 3 months. The histological features were evaluated by the histological activity index and fibrosis.

Results: In total, 1299 patients were included in the study. The distribution and the mean of the parameters of the patients were as follows: 1009 patients with chronic hepatitis B with a mean age of 45±13/years [emale/male (F/M)=47.5/52.5%] and 290 patients with hepatitis C with a mean age of 52±10.3/years [F/M=61/39%]. When the cut-off value of the REAL TEST formula"[(age x pT x AST)/(PLT/1000)]/100" in patients with hepatitis B was determined to be ≥1.37, it was found that it could predict fibrosis with 79% specificity, 78% sensitivity, 85% negative predictive value (NPV), and 70% positive predictive value (PPV) (area under the curve (AUC)=0.852, 95% CI:0.82-0.87). When the cut-off value of the REAL TEST formula in patients with hepatitis C was determined to be ≥1.99, it was found that it could predict significant fibrosis with 87% specificity, 90% sensitivity, 94.4% NPV, and 79.4% PPV (AUC:0.95, 95% CI:0.93-0.98).

Conclusion: The REAL TEST formula results correlated with the pathological findings and may be a useful method for the evaluation of patients with chronic hepatitis B and C.

MeSH terms

  • Adult
  • Age Factors
  • Alanine Transaminase / blood
  • Area Under Curve
  • Aspartate Aminotransferases / blood
  • Diagnostic Tests, Routine*
  • Disease Progression
  • Female
  • Hemoglobins / metabolism
  • Hepatitis B, Chronic / blood*
  • Hepatitis B, Chronic / complications
  • Hepatitis B, Chronic / pathology
  • Hepatitis C, Chronic / blood*
  • Hepatitis C, Chronic / complications
  • Hepatitis C, Chronic / pathology
  • Humans
  • International Normalized Ratio
  • Liver Cirrhosis / pathology*
  • Liver Cirrhosis / virology
  • Male
  • Mathematical Concepts*
  • Middle Aged
  • Platelet Count
  • Predictive Value of Tests
  • Prothrombin Time
  • ROC Curve


  • Hemoglobins
  • Aspartate Aminotransferases
  • Alanine Transaminase