SynthesisNature communications2023
Systematic review and individual-patient-data meta-analysis of non-invasive fibrosis markers for chronic hepatitis B in Africa.
Synthesis in Nature communications, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled 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.
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.
Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 39 citations in OpenAlex.
- Diagnostic role of transient elastography in patients with autoimmune liver diseases: A systematic review and meta-analysis.World journal of gastroenterology · 2023Pooled it
- A Distinct Immune Signature Characterizes Cirrhosis in Ethiopian Individuals With Chronic HBV Infection.Alimentary pharmacology & therapeutics · 2026Article
- Liver disease diagnostics and access barriers in African settings: a narrative review.Journal of clinical pathology · 2026Review
- Performance of Serum-Based Non-Invasive Fibrosis Scores Compared with Liver Biopsy in Patients with Chronic Hepatitis B.Medicina (Kaunas, Lithuania) · 2026Article
- WHO 2024 Hepatitis B Guidelines: No more gray zone for low- and middle-income countries? An evaluation.Hepatology forum · 2026Review
- Time to Initiation of Hepatitis B Treatment is Reduced With the Use of the Xpert HBV Viral Load Kit.Open forum infectious diseases · 2025Article
- Feasibility of implementing viral hepatitis services into a correctional service facility in Cape Town, South Africa.The International journal on drug policy · 2025Article
- Real-world experience with nucleos(t)ide analogue therapy and patient survival rates in chronic viral hepatitis B treatment centers in Eritrea.Scientific reports · 2025Article
- Performance of APRI and FIB-4 Scores Compared to FibroScan: A Cross-Sectional Study in a Black Sub-Saharan African Population.Hepatic medicine : evidence and research · 2025Article
- Prevalence of hepatitis B virus infection and treatment eligibility in Lesotho, Southern Africa: a population-based cross-sectional study with case-based follow-up.BMJ public health · 2024Article
- Global elimination of HBV: Is it really achievable?Journal of viral hepatitis · 2024Review
- Liver histology pattern of young patients with inactive chronic hepatitis b virus infection from a hospital in South West Nigeria.BMC gastroenterology · 2024Article
- Using Phosphatidylethanol as an Adjunct to Self-Reported Alcohol Use Improves Identification of Liver Fibrosis Risk.The American journal of gastroenterology · 2024Article
- A New Assessment of Two Transferase-Based Liver Enzymes in Low- and High-Fibrosis Patients Chronically Infected with Hepatitis B Virus: A Meta-Analysis and Pilot Study.Journal of clinical medicine · 2024Article
- Development and evaluation of a simple treatment eligibility score (HEPSANET) to decentralise hepatitis B care in Africa: a cross-sectional study.The lancet. Gastroenterology & hepatology · 2024Article
- Point-of-care ultrasound to inform antiviral treatment initiation in chronic hepatitis B virus infection in low-resource settings - the PUSH protocol.The ultrasound journal · 2024Article
- Non-invasive assessment of hepatic fibrosis among patients with chronic hepatitis B virus infection in three tertiary hospitals in Nigeria.SAGE open medicine · 2024Article
- Enhancing interventions for prevention of mother-to-child- transmission of hepatitis B virus.JHEP reports : innovation in hepatology · 2023Review
- Hepatitis B in Africa Collaborative Network: cohort profile and analysis of baseline data.Epidemiology and infection · 2023Article
- A new approach to prevent, diagnose, and treat hepatitis B in Africa.BMC global and public health · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
23 authors at 17 institutions in 12 countries.
Funding
Abstract
In sub-Saharan Africa, simple biomarkers of liver fibrosis are needed to scale-up hepatitis B treatment. We conducted an individual participant data meta-analysis of 3,548 chronic hepatitis B patients living in eight sub-Saharan African countries to assess the World Health Organization-recommended aspartate aminotransferase-to-platelet ratio index and two other fibrosis biomarkers using a Bayesian bivariate model. Transient elastography was used as a reference test with liver stiffness measurement thresholds at 7.9 and 12.2kPa indicating significant fibrosis and cirrhosis, respectively. At the World Health Organization-recommended cirrhosis threshold (>2.0), aspartate aminotransferase-to-platelet ratio index had sensitivity (95% credible interval) of only 16.5% (12.5-20.5). We identified an optimised aspartate aminotransferase-to-platelet ratio index rule-in threshold (>0.65) for liver stiffness measurement >12.2kPa with sensitivity and specificity of 56.2% (50.5-62.2) and 90.0% (89.0-91.0), and an optimised rule-out threshold (<0.36) with sensitivity and specificity of 80.6% (76.1-85.1) and 64.3% (62.8-65.8). Here we show that the World Health Organization-recommended aspartate aminotransferase-to-platelet ratio index threshold is inappropriately high in sub-Saharan Africa; improved rule-in and rule-out thresholds can optimise treatment recommendations in this setting.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.