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A Three-Dimensional Digital Model for Early Diagnosis of Hepatic Fibrosis Based on Magnetic Resonance Elastography
Published on: July 21, 2023
Optimized stepwise combination algorithms of non-invasive liver fibrosis scores including Hepascore in hepatitis C
M Bourliere1, G Penaranda, D Ouzan
1Département d'Hépato-Gastroentérologie, Hôpital Saint-Joseph, Marseille, France.
Insights
Hepascore (HS) accurately identifies liver fibrosis in hepatitis C virus (HCV) patients, serving as a viable alternative to liver biopsy. Combining HS with other markers like APRI improves diagnostic accuracy and reduces the need for invasive procedures.
Area of Science:
- Hepatology
- Diagnostic Accuracy
- Biomarker Validation
Background:
- Liver biopsy is the gold standard for staging liver fibrosis in Hepatitis C Virus (HCV) patients.
- Non-invasive scores like Hepascore (HS) offer a potential alternative to liver biopsy.
- Validation of existing non-invasive markers is crucial for clinical application.
Purpose of the Study:
- To validate Hepascore (HS) against liver biopsy and Fibrotest (FT) in HCV patients.
- To develop and assess optimized algorithms combining non-invasive markers for improved fibrosis diagnosis.
- To enhance the diagnostic accuracy and reduce the need for liver biopsies.
Main Methods:
- A cohort of 467 HCV patients was analyzed.
- Hepascore (HS), Fibrotest (FT), APRI, and Forns scores were calculated.
- Receiver operating characteristic (ROC) curves were used to determine diagnostic accuracy (AUC).
- Concordance between non-invasive scores and liver biopsy was assessed.
Main Results:
- Hepascore demonstrated high diagnostic accuracy for significant fibrosis (F2, F3F4, F4), with AUCs ranging from 0.82 to 0.90.
- HS and FT showed good concordance (82%) with each other and with liver biopsy (88% among concordant cases).
- An algorithm combining APRI and HS achieved 91% diagnostic accuracy and avoided 45% of liver biopsies.
Conclusions:
- Hepascore is a reliable non-invasive marker for diagnosing liver fibrosis (F2 and F4) in HCV patients.
- Optimized algorithms combining APRI with FT or HS significantly improve diagnostic accuracy.
- These combined approaches increase the rate of avoided liver biopsies, offering a pragmatic clinical strategy.
Background:
Non-invasive liver fibrosis scores such as Hepascore (HS) have been proposed as an alternative to liver biopsy in hepatitis C virus (HCV)-infected patients.
Aim:
To validate HS as an alternative to liver biopsy and Fibrotest (FT) and propose five optimized combination algorithms to improve diagnostic accuracy.
Methods:
The cohort included 467 patients with HCV. There were 274/467 (59%) men, and mean age was 47 +/- 12 years.
Results:
Hepascore area under ROC curves (AUC) for > or =F2, F3F4 and F4 diagnosis were 0.82, 0.84 and 0.90 respectively, in the same range as FT. HS and FT were concordant in 387/467 (82%) for fibrosis staging. Among these patients, 342/387 (88%) were concordant with liver biopsy. AUCs of aspartate aminotransferase (AST) to Platelets Ratio Index (APRI) and Forns for > or =F2 were 0.76 and 0.73 (0.65-0.79) respectively. The algorithm combining APRI and HS had the highest rate of avoided liver biopsies (45%) with a high diagnostic accuracy (91%).
Conclusions:
Hepascore is an accurate non-invasive marker for > or =F2 and F4 diagnosis in HCV patients. In a pragmatic approach, a stepwise optimized algorithm combining APRI and FT or HS considerably increases diagnostic accuracy and avoided liver biopsies.
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