Supplementary tables
Supplementary Table 1. Non-invasive serum markers for assessing liver fibrosis stage currently available in Australia |
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Method |
Formula |
Key threshold for excluding cirrhosis* |
APRI |
APRI = (AST [IU/L] ÷ AST ULN [IU/L] × 100) ÷ platelet count ( × 109/L) |
APRI < 1.0 |
Hepascore |
Patented formula combining bilirubin, gamma-glutamyl transferase, hyaluronate, α-2-macroglobulin, age and sex |
Hepascore < 0.80 |
FibroGENE |
Patented formula based on age, platelet count, AST, GGT and IFNL3 (rs12979860) genotype |
Threshold not published but online calculator available |
ELF test |
Patented formula combining age, hyaluronate, MMP-3 and TIMP-1 |
ELF < 9.8 |
APRI = AST to platelet ratio index. AST = aspartate aminotransferase. ELF = Enhanced Liver Fibrosis. GGT = gamma-glutamyl transferase. HIV = human immunodeficiency virus. MMP-3 = matrix metalloproteinase-3. TIMP-1 = tissue inhibitor of metalloproteinase-1. ULN = upper limit of normal. * These thresholds have good performance characteristics for excluding the presence of cirrhosis. Patients in whom results exceed these thresholds should be referred for further assessment for the presence of cirrhosis by a specialist with experience in assessing liver disease severity and managing patients with advanced liver disease. These thresholds alone should not be used to diagnose cirrhosis. Note that the performance of Hepascore and APRI for predicting the presence of cirrhosis may be less accurate in people with HIV coinfection than in people with HCV mono-infection (be aware of false positive results due to HIV-induced thrombocytopaenia with APRI, or antiretroviral treatment-related hyperbilirubinaemia with Hepascore). References: · EASL-ALEH clinical practice guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol 2015; 63: 237-264. · World Health Organization. Guidelines for the screening, care and treatment of persons with hepatitis C infection. April 2014. (http://apps.who.int/iris/bitstream/10665/111747/1/9789241548755_eng.pdf?ua=1) · Lin ZH, Xin YN, Dong QJ, et al. Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis. Hepatology 2011; 53 (3): 726-736. · Adams LA, Bulsara M, Rossi E, et al. Hepascore: an accurate validated predictor of liver fibrosis in chronic hepatitis C infection. Clin Chem 2005; 51: 1867-1873. · Eslam M, Hashem AM, Romero-Gomez M, et al. FibroGENE: a gene-based model for staging liver fibrosis. J Hepatol 2016; 64: 390-398. · Parkes J, Guha IN, Roderick P, et al. Enhanced Liver Fibrosis (ELF) test accurately identifies liver fibrosis in patients with chronic hepatitis C. J Viral Hepat 2011; 18: 23-31. |