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Hepatology International

, Volume 13, Issue 1, pp 91–101 | Cite as

Systematic review: diagnostic accuracy of non-invasive tests for staging liver fibrosis in autoimmune hepatitis

  • Shanshan Wu
  • Zhirong Yang
  • Jialing Zhou
  • Na Zeng
  • Zhiying He
  • Siyan Zhan
  • Jidong Jia
  • Hong YouEmail author
Original Article
  • 187 Downloads

Abstract

Background and aims

Non-invasive fibrosis assessment has been highly recommended in many liver diseases. However, comparative diagnostic accuracy of laboratory markers, ultrasound and magnetic resonance elastography (MRE) for fibrosis in autoimmune hepatitis (AIH) patients has not been established.

Methods

Medline, Embase and Cochrane Library were searched. Primary outcome was significant fibrosis (SF), advanced fibrosis (AF) and cirrhosis, defined as Metavir stage F ≥ 2, F ≥ 3 and F = 4 according to liver biopsy. Hierarchical summary receiver operating characteristic curve (ROC) model was used to evaluate diagnostic accuracy of non-invasive methods. Summary area under ROC (AUROC) and diagnostic odds ratio (DOR) with 95% confidence interval (CI) were calculated. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess quality of evidence.

Results

Overall, 16 studies with 861 patients were included, comparing aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 index (FIB-4), aspartate aminotransferase/alanine aminotransferase ratio, transient elastography (TE), acoustic radiation force impulse, shear wave elastography and MRE versus liver biopsy. Among all non-invasive markers, TE had good performance for fibrosis staging. Summary AUROCs and DORs of TE were 0.90 (95% CI 0.87, 0.92) and 23.7, 0.91 (95% CI 0.89, 0.93) and 31.6, 0.89 (95% CI 0.86, 0.92) and 80.5 for staging SF, AF and cirrhosis, whereas APRI and FIB-4 showed poor performance for detecting AF (DOR, 4.6 and 4.7) and cirrhosis (DOR, 5.5 and 12.9).

Conclusions

TE performs well to stage liver fibrosis in patients with AIH, compared with other laboratory non-invasive indexes. Nevertheless, diagnostic accuracy of APRI and FIB-4 is poor.

Keywords

Autoimmune hepatitis Liver fibrosis Non-invasive methods Transient elastography 

List of abbreviations

AIH

Autoimmune hepatitis

MRE

Magnetic resonance elastography

SF

Significant fibrosis

AF

Advanced fibrosis

ROC

Receiver operating characteristic curve

AUROC

Summary area under ROC

DOR

Diagnostic odds ratio

CI

Confidence interval

APRI

Aspartate aminotransferase to platelet ratio index

FIB-4

Fibrosis-4 index

AAR

Aspartate aminotransferase/alanine aminotransferase ratio

TE

Transient elastography

ARFI

Acoustic radiation force impulse

SWE

Shear wave elastography

HCC

Hepatocellular carcinoma

AASLD

American Association for the Study of Liver Diseases

EASL

European Association for the Study of the Liver

AST

Aspartate aminotransferase

ALT

Alanine aminotransferase

PC/SD

Platelet count to spleen diameter

NAFLD

Non-alcoholic fatty liver disease

PPV

Positive predictive value

NPV

Negative predictive value

QUADAS-2

Quality Assessment of Diagnostic Accuracy Studies-2 scale

GRADE

The Grading of Recommendations Assessment Development and Evaluation

LR+

Positive likelihood ratio

LR−

Negative likelihood ratio

ULN

Upper limit normal

Notes

Acknowledgements

We are grateful to all cooperating organizations and their staff whose hard work made this study possible. ZRY is supported by the Cambridge Trust and the China Scholarship Council. Thanks to Prof. Jing Hua for supplying cut-off value, sensitivity and specificity of APRI and FIB-4 detecting advanced fibrosis.

Authorship

SSW and HY designed the study and drafted the manuscript. SSW, NZ, ZYH and JLZ extracted the data, SSW, ZRY, and SYZ evaluated the quality. SSW, ZRY, and SYZ assessed the quality of evidence by GRADE framework. SSW and ZRY analyzed the data. HY and JDJ interpreted the results, incorporated comments for the co-authors and finalized the manuscript. All authors approved the final version of the paper.

Financial support

This study is funded by Beijing Municipal Administration of Hospitals’ Youth Program (QML20170107) and Beijing Talents Fund (2016000021469G226). The sponsor had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Compliance with ethical standards

Conflict of interest

Shanshan Wu, Zhirong Yang, Jialing Zhou, Na Zeng, Zhiying He, Siyan Zhan, Jidong Jia, and Hong You have no conflict of interests.

Supplementary material

12072_2018_9907_MOESM1_ESM.docx (179 kb)
Supplementary material 1 (DOCX 180 kb)

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Copyright information

© Asian Pacific Association for the Study of the Liver 2018

Authors and Affiliations

  • Shanshan Wu
    • 1
  • Zhirong Yang
    • 2
    • 3
  • Jialing Zhou
    • 1
  • Na Zeng
    • 1
  • Zhiying He
    • 1
  • Siyan Zhan
    • 4
  • Jidong Jia
    • 1
    • 5
  • Hong You
    • 1
    • 5
    Email author
  1. 1.National Clinical Research Center of Digestive Diseases, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
  2. 2.Primary Care Unit, Department of Public Health and Primary Care, School of Clinical MedicineUniversity of CambridgeCambridgeUK
  3. 3.Department of Population Medicine, Harvard Medical SchoolHarvard Pilgrim Health Care InstituteBostonUSA
  4. 4.Department of Epidemiology and Biostatistics, School of Public HealthPeking University Health Science CentreBeijingChina
  5. 5.Liver Research Center, Beijing Friendship HospitalCapital Medical UniversityBeijingChina

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