Johannessen, Asgeir; Stockdale, Alexander J; Henrion, Marc Y R; 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; ... (2023). Systematic review and individual-patient-data meta-analysis of non-invasive fibrosis markers for chronic hepatitis B in Africa. Nature communications, 14(1), p. 45. Nature Publishing Group 10.1038/s41467-022-35729-w
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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: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM) |
UniBE Contributor: |
Wandeler, Gilles |
Subjects: |
600 Technology > 610 Medicine & health 300 Social sciences, sociology & anthropology > 360 Social problems & social services |
ISSN: |
2041-1723 |
Publisher: |
Nature Publishing Group |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
11 Jan 2023 14:42 |
Last Modified: |
15 Jan 2023 02:18 |
Publisher DOI: |
10.1038/s41467-022-35729-w |
PubMed ID: |
36596805 |
BORIS DOI: |
10.48350/176793 |
URI: |
https://boris.unibe.ch/id/eprint/176793 |
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