Peta V, Sandler Y, Deckmyn O, Duroselle O, Vinnitskaya E, Khomeriki S, Noskova K, Poynard T. Diagnostic performance of FibroTest-ActiTest, transient elastography, and the fibrosis-4 index in patients with autoimmune hepatitis using histological reference. World J Hepatol 2025; 17(3): 104534 [DOI: 10.4254/wjh.v17.i3.104534]
Corresponding Author of This Article
Thierry Poynard, Professor Emerita, Sorbonne Université, INSERM Centre de Recherche Saint-Antoine, 27 rue de Chaligny, Paris 75012, France. thierry@poynard.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Mar 27, 2025; 17(3): 104534 Published online Mar 27, 2025. doi: 10.4254/wjh.v17.i3.104534
Diagnostic performance of FibroTest-ActiTest, transient elastography, and the fibrosis-4 index in patients with autoimmune hepatitis using histological reference
Valentina Peta, Olivier Deckmyn, Oksana Duroselle, Thierry Poynard, BioPredictive, Paris 75007, France
Yuliya Sandler, Elena Vinnitskaya, Department of Hepatology, Center for Diagnostics and Treatment of Liver Diseases, Moscow Clinical Scientific and Practical Center, Moscow 111123, Russia
Sergey Khomeriki, Laboratory of Pathomorphology, Moscow Clinical Scientific and Practical Center, Moscow 111123, Russia
Karina Noskova, Clinical Diagnostic Laboratory, Moscow Clinical Scientific and Practical Center, Moscow 111123, Russia
Thierry Poynard, Sorbonne Université, INSERM Centre de Recherche Saint-Antoine, Paris 75012, France
Co-first authors: Valentina Peta and Yuliya Sandler.
Author contributions: Peta V and Sandler Y designed the study and interpreted the data; They contributed equally to this article, and they are the co-first authors of this manuscript; Peta V, Sandler Y, and Poynard T wrote the manuscript; Peta V, Poynard T, and Deckmyn O analyzed the data; Sandler Y, Duroselle O, Vinnitskaya E, Khomeriki S, and Noskova K acquired the data; All authors critically reviewed and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Moscow Clinical Scientific Center, approval No. АААА-А18-118021590195-4 at www.rosrid.ru.
Informed consent statement: All study participants provided informed written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Thierry Poynard, Professor Emerita, Sorbonne Université, INSERM Centre de Recherche Saint-Antoine, 27 rue de Chaligny, Paris 75012, France. thierry@poynard.com
Received: December 24, 2024 Revised: February 23, 2025 Accepted: March 6, 2025 Published online: March 27, 2025 Processing time: 92 Days and 19.6 Hours
Abstract
BACKGROUND
Noninvasive tests are crucial for the management and follow-up of patients with autoimmune hepatitis, but their validation is limited because of insufficient data.
AIM
To investigate the diagnostic performance of three fibrosis noninvasive tests [FibroTest, vibration-controlled transient elastography (VCTE), and the fibrosis-4 index (FIB-4) and two activity biomarkers (alanine aminotransferase (ALT) and ActiTest].
METHODS
This study enrolled 103 patients for whom liver biopsy, hepatic elastography results, and laboratory markers were available. Diagnostic performance was assessed with receiver operating characteristic (ROC) curves, the Obuchowski measure (OM), and the Bayesian latent class model.
RESULTS
FibroTest and VCTE outperformed FIB-4 in cases of significant fibrosis (≥ F2), with areas under the ROC curve of 0.83 [95% confidence interval (CI): 0.73-0.90], 0.86 (95%CI: 0.77-0.92), and 0.71 (95%CI: 0.60-0.80), respectively. The mean (standard error) OM values were 0.92 (0.01), 0.93 (0.01), and 0.88 (0.02) for FibroTest, VCTE, and FIB-4, respectively; FibroTest and VCTE performed comparably, and both were superior to FIB-4 (P = 0.03 and P = 0.005). The areas under the ROC curve values for activity biomarkers were 0.86 (95%CI: 0.76-0.92) for ActiTest and 0.84 (95%CI: 0.73-0.90) for ALT (P = 0.06). The OM values for ActiTest and ALT were 0.92 (0.02) and 0.90 (0.02), respectively (P = 0.005).
CONCLUSION
FibroTest and VCTE outperformed FIB-4 according to the OM. FibroTest-ActiTest facilitated the evaluation of both fibrosis and activity.
Core Tip: Our study investigated the efficacy of noninvasive tests in assessing liver fibrosis in autoimmune hepatitis (AIH). Using the Obuchowski measure, we found that FibroTest and vibration-controlled transient elastography outperformed the fibrosis-4 index in the detection of liver fibrosis. FibroTest showed promising results in AIH. ActiTest demonstrated superior performance in the estimation of inflammatory activity compared to alanine aminotransferase and IgG levels. The Bayesian latent class model confirmed the robustness of these noninvasive tests, highlighting their potential to complement liver biopsy in AIH management, particularly during follow-up when repeated biopsies are impractical.
