Prognostic Value of Liver Fibrosis Biomarkers: A Meta-Analysis

Abstract: Aims and Methods: Several serum biomarkers such as FibroTest, aspartate transaminase–platelet ratio index (APRI), FIB-4, and liver stiffness measurement by FibroScan have been validated as alternatives to biopsy for the diagnosis of fibrosis in patients with chronic liver disease. This paper aims to assess the 5-year prognostic values of these biomarkers. A meta-analysis combined all published prognostic studies. Baseline biopsy and APRI data were used as references. Results: Only 3 biomarkers had several prognostic validations: FibroTest (4 studies; 2,396 patients), APRI (5 studies; 2,422 patients), and FIB-4 (3 studies; 1,184 patients). For the prediction of survival without liver-related death, the areas under the receiver operating characteristic curves (AUROCs) were 0.86 for biopsy (95% confidence interval [CI], 0.77–0.95), 0.88 for FibroTest (95% CI, 0.79–0.98), 0.73 for FIB-4 (95% CI, 0.62–0.85), and 0.66 for APRI (95% CI, 0.57–0.75). APRI had a significantly lower prognostic value versus biopsy, with a mean difference between AUROCs of –0.21 (95% CI, –0.33 to –0.10; P<.001); FIB-4 had a significantly lower prognostic value versus biopsy, with a mean difference between AUROCs of –0.21 (95% CI, –0.20 to –0.02; P=.02). Only FibroTest did not show a significant difference in prognostic value versus biopsy, with a mean difference in AUROCs of +0.02 (95% CI, –0.05 to +0.09; P=.85). Conclusion: FibroTest is a validated biomarker for the prognosis of patients with chronic liver disease.