Fibrotest-Actitest™: The biochemical marker of liver fibrosis - The Israeli experience

Background: The Fibrotest-Actitest™ is a six-parameter scoring system that allows quantification of liver fibrosis and inflammation. This test has been validated by several studies in hepatitis B and C viruses and alcoholic liver disease, with a high correlation between the liver biopsy and the results of the FT-AT (AUROC between 0.78 and 0.95). The FT-AT was introduced in Israel (Rambam Laboratory) in March 2005. Objectives: To assess the results of HCV patients who underwent the test during the period March 2005 to February 2006. Methods: Serum was taken and brought to the central laboratory performing the tests within 4 hours. Six parameters were evaluated using commercial kits approved by the designer of the test (Biopredictive): total billrubin, gamma-glutamyltransferase, alpha-2 macroglobulin, haptoglobin, alanine aminotransferase, and apolipoprotein-A1. The results were sent to the website of Biopredictive (France), which provided the FT-AT score online using a patented formula. Results: Of the 325 patients tested, only 4 were not interpretable because of hemolysis. Patents' age ranged from 7 to 72 years (median 42); 54% were female. Liver biopsy was performed in 81 patents and was compared with the results of the Fibrotest. Findings were as follows: 27% of the patients were F0, 19% F1, 20% F2, 17% F3 and 17% F4; 18% were A0, 32% A1, 28% A2 and 22% A3. The AUROC curve comparing the Fibrotest with liver biopsy with a cutoff point at F2 and A2 for significant fibrosis and inflammation was 0.85 and 0.79 respectively. Conclusion: Fibrotest is a simple and effective method to assess liver fibrosis and Inflammation and can be considered an alternative to liver biopsy in most patients with HCV.