Staging chronic hepatitis C in seven categories using fibrosis biomarker (FibroTest™) and transient elastography (FibroScan®)

Thierry Poynard, Julien Vergniol, Yen Ngo, Juliette Foucher, Mona Munteanu, Wassil Merrouche, Massimo Colombo, Vincent Thibault, Eugene Schiff, Clifford A. Brass, Janice K. Albrecht, Marika Rudler, Olivier Deckmyn, Pascal Lebray, Dominique Thabut, Vlad Ratziu, Victor De Ledinghen

Research output: Contribution to journalArticlepeer-review

75 Scopus citations


Background & Aims FibroTest™ (FT) and Transient Elastography (TE) have been validated as non-invasive markers of METAVIR fibrosis stages from F0 to F4 using biopsy, and as prognostic markers of liver related mortality in patients with chronic hepatitis C. The aim was to extend the validation of FT and TE as markers of critical steps defined by occurrence of cirrhosis without complications (F4.1), esophageal varices (F4.2), and severe complications (F4.3): primary liver cancer, variceal bleeding, or decompensation (ascites, encephalopathy, or jaundice). Methods The updated individual data of 3927 patients (1046 cirrhotics) without complications at baseline were pooled from three prospective cohorts called "EPIC", "Paris", and "Bordeaux" cohorts. Results At 5 years, among 501 patients without varices at baseline (F4.1) varices occurred in 19 patients [F4.2 incidence of 4.0% (95% CI 2.2-5.8)]. The predictive performance (AUROC) of FT was 0.77 (0.66-0.84; p <0.001). At 10 years severe complications occurred in 203 patients, [F4.3 incidence of 13.4% (9.6-17.1)], including primary liver cancer in 84 patients [6.4% (3.5-9.3)]. FT was predictive (Cox adjusted on treatment) of severe complications [AUROC 0.79 (76-82); p <0.0001], including primary liver cancer [AUROC 0.84 (80-87); p <0.0001]. Similarly TE was predictive of severe complications [AUROC 0.77 (72-81); p <0.0001], including primary liver cancer [AUROC 0.86 (81-90); p <0.0001]. Conclusions FibroTest™ and TE increase were associated with the occurrence of all severe complications including hepatocellular carcinoma, hepatic insufficiency, and variceal bleeding. FibroTest™ increase was also associated with the occurrence of esophageal varices.

Original languageEnglish (US)
Pages (from-to)706-714
Number of pages9
JournalJournal of Hepatology
Issue number4
StatePublished - Apr 2014


  • Cirrhosis complications
  • Elastography
  • Fibrosis stages
  • FibroTest™
  • Hepatocellular carcinoma
  • Prognostic factors
  • Surrogate markers

ASJC Scopus subject areas

  • Hepatology


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