Validation of Ten Noninvasive Diagnostic Models for Prediction of Liver Fibrosis in Patients with Chronic Hepatitis B

PLoS One. 2015 Dec 28;10(12):e0144425. doi: 10.1371/journal.pone.0144425. eCollection 2015.


Background and aims: Noninvasive models have been developed for fibrosis assessment in patients with chronic hepatitis B. However, the sensitivity, specificity and diagnostic accuracy in evaluating liver fibrosis of these methods have not been validated and compared in the same group of patients. The aim of this study was to verify the diagnostic performance and reproducibility of ten reported noninvasive models in a large cohort of Asian CHB patients.

Methods: The diagnostic performance of ten noninvasive models (HALF index, FibroScan, S index, Zeng model, Youyi model, Hui model, APAG, APRI, FIB-4 and FibroTest) was assessed against the liver histology by ROC curve analysis in CHB patients. The reproducibility of the ten models were evaluated by recalculating the diagnostic values at the given cut-off values defined by the original studies.

Results: Six models (HALF index, FibroScan, Zeng model, Youyi model, S index and FibroTest) had AUROCs higher than 0.70 in predicting any fibrosis stage and 2 of them had best diagnostic performance with AUROCs to predict F≥2, F≥3 and F4 being 0.83, 0.89 and 0.89 for HALF index, 0.82, 0.87 and 0.87 for FibroScan, respectively. Four models (HALF index, FibroScan, Zeng model and Youyi model) showed good diagnostic values at given cut-offs.

Conclusions: HALF index, FibroScan, Zeng model, Youyi model, S index and FibroTest show a good diagnostic performance and all of them, except S index and FibroTest, have good reproducibility for evaluating liver fibrosis in CHB patients.

Registration number: ChiCTR-DCS-07000039.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Aspartate Aminotransferases / analysis
  • Biopsy / methods
  • Elasticity Imaging Techniques / methods
  • Female
  • Hepatitis B Surface Antigens / metabolism
  • Hepatitis B, Chronic / diagnosis*
  • Humans
  • Liver / pathology*
  • Liver / surgery
  • Liver Cirrhosis / diagnosis*
  • Male
  • Reproducibility of Results


  • Hepatitis B Surface Antigens
  • Aspartate Aminotransferases

Associated data

  • ChiCTR/CHICTR-DCS-07000039

Grant support

JYC received the funding from Wang Bao-En Liver Fibrosis Fund (an unrestricted grant from China Foundation for Hepatitis Prevention and Control, ChiCTR-DCS-07000039), Major Science and Technology Special Project of China Twelfth Five-year Plan (2012ZX10002003) and Key Project from Beijing Municipal Science and Technology Commission (Z09050700940902, D121100003912002, D121100003912003) in study design and data collection.