Diagnostic performance of FibroTest-ActiTest, transient elastography, and the fibrosis-4 index in patients with autoimmune hepatitis using histological reference

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.

Keywords: Autoimmune hepatitis; FibroTest; FibroSure; ActiTest; Fibrosis-4 index; Fibrosis; Vibration-controlled transient elastography

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.