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The performance of simple serum-based tests to exclude cirrhosis prior to hepatitis C treatment in nonhospital settings in Australia1.92 MB
Accepted VersionCC BY-NC V4.0, Open Access
Journal article
The performance of simple serum-based tests to exclude cirrhosis prior to hepatitis C treatment in non‐hospital settings in Australia
Internal Medicine Journal, Vol.51(4), pp.533-539
2021
PMID: 31994285
Abstract
Background:
Current guidelines suggest using transient elastography (TE) or APRI score <1 to exclude cirrhosis prior to commencing treatment for hepatitis C (HCV). Recently FIB‐4 <0.93 has been shown to have a high negative predictive value (NPV) for the presence of cirrhosis.
Aims:
We aimed to assess FIB‐4 and APRI in our cohort of HCV patients and to validate FIB‐4 <0.93 in populations of HCV infected individuals with differing cirrhosis prevalence, including secondary care, primary care, and prisons.
Methods:
From our treatment database we identified patients with complete data (n= 793). We calculated FIB‐4 and APRI and correlated this with the presence of cirrhosis, determined by TE. We analysed the performance of FIB‐4 and APRI using AUROC analysis. We calculated sensitivity, specificity, positive predictive value, NPV, and number of patients misclassified using published cut‐offs in populations with varying cirrhosis prevalence.
Results:
FIB‐4 was superior to APRI for the diagnosis of cirrhosis (AUROC 0.868 vs 0.802). In secondary care (cirrhosis prevalence 32%), APRI <1 had a NPV of 80% and misclassified 14% of patients. FIB‐4 <0.93 had a NPV of 97% and misclassified 1%. In primary care and prison (cirrhosis prevalence 13 and 8%), the NPV for APRI <1 was 93% and 96% respectively but 5% of patients with cirrhosis were misclassified. FIB‐4 <0.93 had excellent NPV in both primary care (97%) and prisoners (100%).
Conclusions:
FIB‐4 <0.93 is highly efficient at ruling out cirrhosis in HCV patients and allows TE to be appropriately avoided, thereby streamlining treatment algorithms.
Details
- Title
- The performance of simple serum-based tests to exclude cirrhosis prior to hepatitis C treatment in non‐hospital settings in Australia
- Authors
- Lauren Burrage (Corresponding Author) - The University of QueenslandHenry Zimmerman (Author) - The University of QueenslandSarah Higgins (Author) - Sunshine Coast University HospitalKerrin Param (Author) - Sunshine Coast University HospitalClare Orme (Author) - Sunshine Coast University HospitalJonathan Mitchell (Author) - Sunshine Coast University HospitalJames O'Beirne (Author) - Sunshine Coast University Hospital
- Publication details
- Internal Medicine Journal, Vol.51(4), pp.533-539
- Publisher
- Wiley-Blackwell Publishing Asia
- Date published
- 2021
- DOI
- 10.1111/imj.14767
- ISSN
- 1445-5994; 1444-0903
- PMID
- 31994285
- Copyright note
- Copyright (c) 2021. This is the peer reviewed version of the following article: Burrage, L., Zimmerman, H., Higgins, S., Param, K., Orme, C., Mitchell, J. and O'Beirne, J. (2021), Performance of simple serum‐based tests to exclude cirrhosis prior to hepatitis C treatment in non‐hospital settings in Australia. Intern Med J, 51: 533-539. https://doi.org/10.1111/imj.14767, which has been published in final form at https://doi.org/10.1111/imj.14767. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
- Grant note
- This study is an analysis of data generated from a project funded by the Integrated Care Innovation fund from the Clinical Excellence Division Queensland.
- Organisation Unit
- University of the Sunshine Coast, Queensland; School of Health and Behavioural Sciences - Legacy
- Language
- English
- Record Identifier
- 99498808102621
- Output Type
- Journal article
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