Johannessen, Asgeir, Stockdale, Alexander J 
ORCID: 0000-0002-5828-3328, Henrion, Marc YR ORCID: 0000-0003-1242-839X, Okeke, Edith, Seydi, Moussa, Wandeler, Gilles, Sonderup, Mark, Spearman, C Wendy, Vinikoor, Michael, Sinkala, Edford et al (show 13 more authors)
(2023)
Systematic review and individual-patient-data meta-analysis of non-invasive fibrosis markers for chronic hepatitis B in Africa.
NATURE COMMUNICATIONS, 14 (1).
45-.
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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Hepatitis B, Chronic, Liver Cirrhosis, Fibrosis, Aspartate Aminotransferases, Platelet Count, Bayes Theorem, ROC Curve, Africa, Biomarkers |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 06 Jan 2023 11:05 |
| Last Modified: | 28 Apr 2023 18:05 |
| DOI: | 10.1038/s41467-022-35729-w |
| Open Access URL: | https://doi.org/10.1038/s41467-022-35729-w |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3166879 |
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