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Johannessen, Asgeir, Stockdale, Alexander J., Henrion, Marc, Okeke, Edith, Seydi, Moussa, Wandeler, Gilles, Sonderup, Mark, Spearman, C. Wendy, Vinikoor, Michael, Sinkala, Edford, Desalegn, Hailemichael, Fall, Fatou, Riches, Nicholas, Davwar, Pantong, Duguru, Mary, Maponga, Tongai, Taljaard, Jantjie, Matthews, Philippa C., Andersson, Monique, Mboup, Souleyman, Sombie, Roger, Shimakawa, Yusuke and Lemoine, Maud (2023) 'Systematic review and individual-patient-data meta-analysis of non-invasive fibrosis markers for chronic hepatitis B in Africa'. Nature Communications, Vol 14, Issue 1, e45.
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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 |
|---|---|
| Subjects: | WC Communicable Diseases > WC 20 Research (General) WC Communicable Diseases > Virus Diseases > Viral Hemorrhagic Fevers. Other Virus Diseases > WC 536 Human viral hepatitis WI Digestive System > WI 700 Liver |
| Faculty: Department: | Clinical Sciences & International Health > Clinical Sciences Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1038/s41467-022-35729-w |
| SWORD Depositor: | JISC Pubrouter |
| Depositing User: | JISC Pubrouter |
| Date Deposited: | 07 Feb 2023 10:05 |
| Last Modified: | 07 Feb 2023 10:05 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/21735 |
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