Evidence map›Paper›PMID 28222249›Full record

ArticleLiver international : official journal of the International Association for the Study of the Liver2017

Are non-invasive fibrosis markers for chronic hepatitis B reliable in sub-Saharan Africa?

Hailemichael Desalegn, Hanna Aberra, Nega Berhe, Svein G Gundersen, Asgeir Johannessen

Open access · hybridAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Liver international : official journal of the International Association for the Study of the Liver, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 3 pooled it
3.5field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 3 syntheses or guidelines pooled it, 44 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 4 institutions in 2 countries.

Hailemichael DesalegnMedical Department, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Hanna AberraMedical Department, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Nega BerheAklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
Svein G GundersenResearch Unit, Sørlandet Hospital HF, Kristiansand, Norway.
Asgeir JohannessenCentre for Imported and Tropical Diseases, Oslo University Hospital, Ullevål, Oslo, Norway.ORCID 0000-0001-5966-7166
St. Paul's Hospital Millennium Medical College · ETAddis Ababa University · ETOslo University Hospital · NOUniversity of Agder · NO

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn the absence of liver biopsy, the World Health Organization recommends non-invasive tests, such as aspartate aminotransferase to platelet ratio index and FIB-4, to assess liver fibrosis in patients with chronic hepatitis B. However, these tests are not well validated in sub-Saharan Africa. Recently, a new marker, gamma-glutamyl transpeptidase to platelet ratio, was found to be more accurate in an African setting, but this needs confirmation in other cohorts.

methodsA treatment program for chronic hepatitis B was initiated in Addis Ababa, Ethiopia, in 2015. Non-invasive tests were compared with transient elastography (Fibroscan 402, Echosense, France) using the following thresholds: no fibrosis (≤7.9 kPa), significant fibrosis (>7.9 kPa) and cirrhosis (>11.7 kPa). The diagnostic accuracy was estimated by calculating the area under the receiver operating characteristics curve.

resultsOf 582 treatment-naïve patients, 141 (24.2%) had significant fibrosis and 90 (15.5%) had cirrhosis. The area under the receiver operating characteristics curve of aspartate aminotransferase to platelet ratio index, FIB-4 and gamma-glutamyl transpeptidase to platelet ratio was high both to diagnose significant fibrosis (0.79 [95% CI 0.75-0.84], 0.79 [95% CI 0.75-0.84], 0.80 [95% CI 0.75-0.85]) and cirrhosis (0.86 [95% CI 0.81-0.91], 0.86 [95% CI 0.81-0.91], 0.87 [95% CI 0.82-0.91]). The specificity was high for all tests (94%-100%); however, the sensitivity was poor both to detect fibrosis (10%-45%) and cirrhosis (10%-36%).

conclusionsAspartate aminotransferase to platelet ratio index, FIB-4 and gamma-glutamyl transpeptidase to platelet ratio had good diagnostic properties to detect liver fibrosis and cirrhosis in patients with chronic hepatitis B in East Africa. However, the sensitivity was low, and only 10% of patients with cirrhosis were detected using aspartate aminotransferase to platelet ratio index at the World Health Organization recommended threshold.

Indexed as

Blood PlateletsClinical Enzyme TestsAdultArea Under CurveAspartate AminotransferasesBiomarkersElasticity Imaging TechniquesEthiopiaFemalegamma-GlutamyltransferaseHepatitis B, ChronicHumansLiver CirrhosisMalePlatelet CountPredictive Value of TestsAspartate AminotransferasesBiomarkersgamma-Glutamyltransferasegamma-glutamyltransferase, humanhepatitis B virusliver fibrosisnon-invasive testssub-Saharan Africa

Identifiers

PMID28222249
PMCPMC5637891
OpenAlexW2589312941

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.