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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Non-invasive tests for predicting liver outcomes in chronic hepatitis C patients: A systematic review and meta-analysis
Tanat Yongpisarn, Chanattha Thimphitthaya, Passisd Laoveeravat, Nicha Wongjarupong, Roongruedee Chaiteerakij
Tanat Yongpisarn, Chanattha Thimphitthaya, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Bangkok 10330, Thailand
Passisd Laoveeravat, Division of Digestive Diseases and Nutrition, Department of Medicine, University of Kentucky, Lexington, KY 40536, United States
Nicha Wongjarupong, Department of Internal Medicine, University of Minnesota, Minneapolis, MN 55455, United States
Roongruedee Chaiteerakij, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
Roongruedee Chaiteerakij, Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: Yongpisarn T contributed to acquisition of data, data analysis and interpretation, drafting the article, and final approval; Thimphitthaya C contributed to acquisition of data, analysis and interpretation of data, drafting the article, and final approval; Laoveeravat P contributed to analysis and interpretation of data and final pproval; Wongjarupong N contributed to analysis and interpretation of data and final approval; Chaiteerakij R contributed to study concept, interpretation of data, critical revision, and final approval.
Supported by Research Grant for New Scholar Ratchadaphiseksomphot Endowment Fund Chulalongkorn University, No. RGN_2559_055_10_30.
Conflict-of-interest statement: The authors deny any conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
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:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Roongruedee Chaiteerakij, MD, PhD, Associate Professor, Doctor, Lecturer, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Road, Patumwan, Bangkok 10330, Thailand. roon.chaiteerakij@chula.md
Received: March 25, 2021
Peer-review started: March 25, 2021
First decision: June 4, 2021
Revised: June 14, 2021
Accepted: July 13, 2021
Article in press: July 13, 2021
Published online: August 27, 2021
ARTICLE HIGHLIGHTS
Research background
Non-invasive tests (NITs) have reduced the need for liver biopsy in chronic hepatitis C (CHC) patients. Despite its limited diagnostic performance in patients with an intermediate degree of fibrosis or in post-treatment setting, previous meta-analyses have evidenced the potential of NITs in determining prognosis. However, these studies focused on chronic liver diseases from various etiologies and did not comprehensively explore all liver outcomes.
Research motivation
The authors aimed to explore all validated NITs for liver fibrosis, specifically their ability to predict liver-related outcomes in CHC patients.
Research objectives
The main goal was to determine the prognostic value of NITs for risk stratification in CHC patients.
Research methods
A literature search was performed to identify CHC cohort studies that reported an association between liver fibrosis assessment by NITs and outcomes such as hepatocellular carcinoma. Hazard ratios (HR) and area under the receiver operating characteristic from those studies were then pooled using the random effects model. Subgroup analyses were performed based on treatment status, treatment regimen, countries, and different cutoff points.
Research results
Fibrosis-4 (FIB-4) index, aspartate aminotransferase to platelet ratio (APRI) score, and liver stiffness measurement (LSM) were found to have hepatocellular carcinoma predictive potential with pooled adjusted HR of 2.48 (95%CI: 1.91-3.23, I2 = 96%), 4.24 (95%CI: 2.15-8.38, I2 = 20%) and 7.90 (95%CI: 3.98-15.68, I2 = 52%) and area under the receiver operating characteristic of 0.81 (95%CI: 0.73-0.89, I2 = 77%), 0.81 (95%CI: 0.75-0.87, I2 = 68%) and 0.79 (95%CI: 0.63-0.96, I2 = 90%), respectively.
Research conclusions
FIB-4, APRI, and LSM were found to have prognostic value, and can potentially be used to stratify risk for CHC patients, regardless of their treatment status or regimen.
Research perspectives
To facilitate clinical implementation, validation of FIB-4, APRI and LSM cutoff levels are needed.
