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      Is Open Access

      The Diagnostic Value of the FIB-4 Index for Staging Hepatitis B-Related Fibrosis: A Meta-Analysis

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      PLoS ONE
      Public Library of Science

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          Abstract

          Background

          Liver fibrosis stage is an important factor in determining prognosis and need for treatment in patients infected with hepatitis B virus (HBV). Liver biopsies are typically used to assess liver fibrosis; however, noninvasive alternatives such as the FIB-4 index have also been developed.

          Aims

          To quantify the accuracy of the FIB-4 index in the diagnosis of HBV related fibrosis and cirrhosis.

          Methods

          A meta-analysis of studies comparing the diagnostic accuracy of the FIB-4 index vs. liver biopsy in HBV-infected patients was performed using studies retrieved from the following databases: PubMed, Ovid, EMBASE, the Cochrane Library, the Chinese National Knowledge Infrastructure and the Chinese Biology Medicine disc. A hierarchical summary receiver operating curves model and bivariate model were used to produce summary receiver operating characteristic curves and pooled estimates of sensitivity and specificity. The heterogeneity was explored with meta-regression analysis. Publication bias was detected using Egger’s test and the trim and fill method.

          Results

          12 studies ( N = 1,908) and 10 studies ( N = 2,105) were included in the meta-analysis for significant fibrosis and cirrhosis, respectively. For significant fibrosis, the area under the hierarchical summary receiver operating curve (AUHSROC) was 0.78 (95% CI = 0.74–0.81). The recommended cutoff value was between 1.45 and 1.62, and the AUHSROC, summary sensitivity and specificity were 0.78 (95% CI = 0.74–0.81), 0.65 (95% CI = 0.56–0.73) and 0.77 (95% CI = 0.7–0.83), respectively. For cirrhosis, the AUHSROC was 0.89 (95% CI = 0.85–0.91). The recommended cutoff value was between 2.9 and 3.6, and the AUHSROC, summary sensitivity and specificity were 0.96 (95% CI = 0.92–1.00), 0.42 (95% CI = 0.36–0.48) and 0.96 (95% CI = 0.95–0.97), respectively. No publication bias was detected.

          Conclusions

          The FIB-4 index is valuable for detecting significant fibrosis and cirrhosis in HBV-infected patients, but has suboptimal accuracy in excluding fibrosis and cirrhosis.

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          Most cited references31

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          • Article: not found

          Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine.

          The clinical performance of a laboratory test can be described in terms of diagnostic accuracy, or the ability to correctly classify subjects into clinically relevant subgroups. Diagnostic accuracy refers to the quality of the information provided by the classification device and should be distinguished from the usefulness, or actual practical value, of the information. Receiver-operating characteristic (ROC) plots provide a pure index of accuracy by demonstrating the limits of a test's ability to discriminate between alternative states of health over the complete spectrum of operating conditions. Furthermore, ROC plots occupy a central or unifying position in the process of assessing and using diagnostic tools. Once the plot is generated, a user can readily go on to many other activities such as performing quantitative ROC analysis and comparisons of tests, using likelihood ratio to revise the probability of disease in individual subjects, selecting decision thresholds, using logistic-regression analysis, using discriminant-function analysis, or incorporating the tool into a clinical strategy by using decision analysis.
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            Histological grading and staging of chronic hepatitis.

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              Classification of chronic viral hepatitis: a need for reassessment.

              P Scheuer (1991)
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                28 August 2014
                : 9
                : 8
                : e105728
                Affiliations
                [1]Department of Laboratory Medicine, The First Affiliated Hospital of the Medical College, Zhejiang University, Hangzhou, China
                University of Utah School of Medicine, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: YC YL. Performed the experiments: YL YZ. Analyzed the data: YL YZ. Contributed reagents/materials/analysis tools: YC. Contributed to the writing of the manuscript: YL YZ.

                Article
                PONE-D-14-15857
                10.1371/journal.pone.0105728
                4148327
                25165830
                84ea6c39-0244-4080-ace6-e19a03d967a7
                Copyright @ 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 9 April 2014
                : 23 July 2014
                Page count
                Pages: 13
                Funding
                The authors have no support or funding to report.
                Categories
                Research Article
                Biology and life sciences
                Microbiology
                Medical microbiology
                Microbial pathogens
                Viral pathogens
                Hepatitis viruses
                Hepatitis B virus
                Custom metadata
                The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files.

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                Uncategorized

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