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Author Notes:

Nabil Saleem, Emory University School of Medicine, 49 Jesse Hill Jr Dr SE, Atlanta 30303, GA (e-mail: nabil.saleem@emory.edu)

Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Writing – original draft: Nabil Saleem, Emily Jeanne Cartwright.

Project administration; Supervision; Validation; Visualization: Emily Jeanne Cartwright.

Writing – review & editing: Nabil Saleem, Lesley Shane Miller, Alia Simjee Dadabhai, Emily Jeanne Cartwright.

Dr. Miller receives grant support from Gilead Sciences, and is on an advisory board for AbbVie.

The remaining authors have no disclosures.



  • Science & Technology
  • Life Sciences & Biomedicine
  • Medicine, General & Internal
  • General & Internal Medicine
  • fibrosis 4 index
  • fibrosis
  • HCV treatment
  • hepatitis C
  • liver fibrinogenesis
  • vibration controlled transient elastography
  • viral hepatitis
  • HIV

Using vibration controlled transient elastography and FIB-4 to assess liver cirrhosis in a hepatitis C virus infected population


Journal Title:



Volume 100, Number 23


, Pages e26200-e26200

Type of Work:

Article | Final Publisher PDF


ABSTRACT: We assessed the performance characteristics of the Fibrosis-4 (FIB-4) score in a veteran population with chronic hepatitis C virus (HCV) infection and used vibration controlled transient elastography (VCTE) as the gold standard.All VCTE studies were performed by a single operator on United States veterans with HCV infection presenting for care at the Atlanta VA Medical Center (AVAMC) over a 2 year period. VCTE liver stiffness measurements (LSM) were categorized as cirrhotic if LSM was >12.5 kPa and non-cirrhotic if LSM was ≤12.5 kPa. FIB-4 scores ≤3.25 were considered non-cirrhotic and scores >3.25 were considered cirrhotic. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for the FIB-4 score. A second analysis was done which identified and excluded indeterminate FIB-4 scores, defined as any value between 1.45 and 3.25.When FIB-4 was used to screen for liver cirrhosis using VCTE as the gold standard, sensitivity was 42%, specificity was 88%, PPV was 62%, and NPV was 76%. When indeterminate FIB-4 scores were excluded from the analysis, sensitivity was 95%, specificity was 61%, PPV was 62%, and NPV was 94.4%. In a veteran population with chronic HCV infection, we found the sensitivity of the FIB-4 score to be unacceptably low for ruling out liver cirrhosis when using a binary cutoff at 3.25. Using a second staging method like VCTE may be an effective way to screen for liver cirrhosis in persons with chronic HCV, especially when the FIB-4 score is in the indeterminate range.

Copyright information:

© 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/).
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