Combination of blood tests for significant fibrosis and cirrhosis improves the assessment of liver‐prognosis in chronic hepatitis C
Summary Background Recent longitudinal studies have emphasised the prognostic value of noninvasive tests of liver fibrosis and cross‐sectional studies have shown their combination significantly improves diagnostic accuracy. Aim To compare the prognostic accuracy of six blood fibrosis tests and liver...
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| Veröffentlicht in: | Alimentary pharmacology & therapeutics 2014-07, Vol.40 (2), p.178-188 |
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| creator | Boursier, J. Brochard, C. Bertrais, S. Michalak, S. Gallois, Y. Fouchard‐Hubert, I. Oberti, F. Rousselet, M.‐C. Calès, P. |
| description | Summary
Background
Recent longitudinal studies have emphasised the prognostic value of noninvasive tests of liver fibrosis and cross‐sectional studies have shown their combination significantly improves diagnostic accuracy.
Aim
To compare the prognostic accuracy of six blood fibrosis tests and liver biopsy, and evaluate if test combination improves the liver‐prognosis assessment in chronic hepatitis C (CHC).
Methods
A total of 373 patients with compensated CHC, liver biopsy (Metavir F) and blood tests targeting fibrosis (APRI, FIB4, Fibrotest, Hepascore, FibroMeter) or cirrhosis (CirrhoMeter) were included. Significant liver‐related events (SLRE) and liver‐related deaths were recorded during follow‐up (started the day of biopsy).
Results
During the median follow‐up of 9.5 years (3508 person‐years), 47 patients had a SLRE and 23 patients died from liver‐related causes. For the prediction of first SLRE, most blood tests allowed higher prognostication than Metavir F [Harrell C‐index: 0.811 (95% CI: 0.751–0.868)] with a significant increase for FIB4: 0.879 [0.832–0.919] (P = 0.002), FibroMeter: 0.870 [0.812–0.922] (P = 0.005) and APRI: 0.861 [0.813–0.902] (P = 0.039). Multivariate analysis identified FibroMeter, CirrhoMeter and sustained viral response as independent predictors of first SLRE. CirrhoMeter was the only independent predictor of liver‐related death. The combination of FibroMeter and CirrhoMeter classifications into a new FM/CM classification improved the liver‐prognosis assessment compared to Metavir F staging or single tests by identifying five subgroups of patients with significantly different prognoses.
Conclusions
Some blood fibrosis tests are more accurate than liver biopsy for determining liver prognosis in CHC. A new combination of two complementary blood tests, one targeted for fibrosis and the other for cirrhosis, optimises assessment of liver‐prognosis. |
| doi_str_mv | 10.1111/apt.12813 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_01389195v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1551629038</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5273-e45b10d9f26b1d4e9c3412c3e90cdc99a6954d0de195a1d3ae4fae781c3ea4d13</originalsourceid><addsrcrecordid>eNqN0b1uFDEQAGALgcgRKHgB5AYJik38tz8uTycgSCdBEWrLa4-zRrv2Ye8dSkdDzzPyJPiyR1Ih4cby6PPMaAahl5Rc0HIu9W6-oKyj_BFaUd7UFSO8eYxWhDWyOsbP0LOcvxJCmpawp-iMia6TtZQr9HMTp94HPfsYcHS4H2O0eIY8Z-xiwtnfBO-80WHGzvcpZp-xDhYbn9Jw9_LTLsUDZDwPgHXOkPMEhZdsoz9A-v3jVwE3YcEBmyHF4A0eYFfKziW4eY6eOD1meHG6z9GX9--uN1fV9tOHj5v1tjI1a3kFou4psdKxpqdWgDRcUGY4SGKskVI3shaWWKCy1tRyDcJpaDtaiBaW8nP0dsk76FHtkp90ulVRe3W13qpjjFDeyfL7cLRvFlua_7YvA1GTzwbGUQeI-6xoXdOGScK7_6BcioZL3j50YMoocwJ33wYl6rhMVZap7pZZ7KtT2n0_gb2Xf7dXwOsT0Nno0SUdjM8PritTEy0p7nJx3_0It_-uqNafr5fSfwDo3riQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1539463937</pqid></control><display><type>article</type><title>Combination of blood tests for significant fibrosis and cirrhosis improves the assessment of liver‐prognosis in chronic hepatitis C</title><source>Access via Wiley Online Library</source><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Wiley Online Library (Open Access Collection)</source><creator>Boursier, J. ; Brochard, C. ; Bertrais, S. ; Michalak, S. ; Gallois, Y. ; Fouchard‐Hubert, I. ; Oberti, F. ; Rousselet, M.‐C. ; Calès, P.</creator><creatorcontrib>Boursier, J. ; Brochard, C. ; Bertrais, S. ; Michalak, S. ; Gallois, Y. ; Fouchard‐Hubert, I. ; Oberti, F. ; Rousselet, M.‐C. ; Calès, P.</creatorcontrib><description>Summary
Background
Recent longitudinal studies have emphasised the prognostic value of noninvasive tests of liver fibrosis and cross‐sectional studies have shown their combination significantly improves diagnostic accuracy.
Aim
To compare the prognostic accuracy of six blood fibrosis tests and liver biopsy, and evaluate if test combination improves the liver‐prognosis assessment in chronic hepatitis C (CHC).
Methods
A total of 373 patients with compensated CHC, liver biopsy (Metavir F) and blood tests targeting fibrosis (APRI, FIB4, Fibrotest, Hepascore, FibroMeter) or cirrhosis (CirrhoMeter) were included. Significant liver‐related events (SLRE) and liver‐related deaths were recorded during follow‐up (started the day of biopsy).
Results
During the median follow‐up of 9.5 years (3508 person‐years), 47 patients had a SLRE and 23 patients died from liver‐related causes. For the prediction of first SLRE, most blood tests allowed higher prognostication than Metavir F [Harrell C‐index: 0.811 (95% CI: 0.751–0.868)] with a significant increase for FIB4: 0.879 [0.832–0.919] (P = 0.002), FibroMeter: 0.870 [0.812–0.922] (P = 0.005) and APRI: 0.861 [0.813–0.902] (P = 0.039). Multivariate analysis identified FibroMeter, CirrhoMeter and sustained viral response as independent predictors of first SLRE. CirrhoMeter was the only independent predictor of liver‐related death. The combination of FibroMeter and CirrhoMeter classifications into a new FM/CM classification improved the liver‐prognosis assessment compared to Metavir F staging or single tests by identifying five subgroups of patients with significantly different prognoses.
Conclusions
Some blood fibrosis tests are more accurate than liver biopsy for determining liver prognosis in CHC. A new combination of two complementary blood tests, one targeted for fibrosis and the other for cirrhosis, optimises assessment of liver‐prognosis.</description><identifier>ISSN: 0269-2813</identifier><identifier>EISSN: 1365-2036</identifier><identifier>DOI: 10.1111/apt.12813</identifier><identifier>PMID: 24889599</identifier><language>eng</language><publisher>Oxford: Blackwell</publisher><subject>Adult ; Biological and medical sciences ; Biopsy ; Female ; Follow-Up Studies ; Gastroenterology. Liver. Pancreas. Abdomen ; Hematologic Tests ; Hepatitis C virus ; Hepatitis C, Chronic - blood ; Hepatitis C, Chronic - diagnosis ; Hepatitis C, Chronic - epidemiology ; Hepatitis C, Chronic - pathology ; Human viral diseases ; Humans ; Infectious diseases ; Life Sciences ; Liver Cirrhosis - blood ; Liver Cirrhosis - diagnosis ; Liver Cirrhosis - epidemiology ; Liver Cirrhosis - pathology ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical sciences ; Middle Aged ; Other diseases. Semiology ; Pharmaceutical sciences ; Prognosis ; Viral diseases ; Viral hepatitis</subject><ispartof>Alimentary pharmacology & therapeutics, 2014-07, Vol.40 (2), p.178-188</ispartof><rights>2014 John Wiley & Sons Ltd</rights><rights>2015 INIST-CNRS</rights><rights>2014 John Wiley & Sons Ltd.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5273-e45b10d9f26b1d4e9c3412c3e90cdc99a6954d0de195a1d3ae4fae781c3ea4d13</citedby><cites>FETCH-LOGICAL-c5273-e45b10d9f26b1d4e9c3412c3e90cdc99a6954d0de195a1d3ae4fae781c3ea4d13</cites><orcidid>0000-0001-7388-0916 ; 0000-0003-4866-5274</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fapt.12813$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fapt.12813$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,315,782,786,887,1419,1435,27933,27934,45583,45584,46418,46842</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28527470$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24889599$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-01389195$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Boursier, J.</creatorcontrib><creatorcontrib>Brochard, C.</creatorcontrib><creatorcontrib>Bertrais, S.</creatorcontrib><creatorcontrib>Michalak, S.</creatorcontrib><creatorcontrib>Gallois, Y.</creatorcontrib><creatorcontrib>Fouchard‐Hubert, I.</creatorcontrib><creatorcontrib>Oberti, F.</creatorcontrib><creatorcontrib>Rousselet, M.‐C.</creatorcontrib><creatorcontrib>Calès, P.</creatorcontrib><title>Combination of blood tests for significant fibrosis and cirrhosis improves the assessment of liver‐prognosis in chronic hepatitis C</title><title>Alimentary pharmacology & therapeutics</title><addtitle>Aliment Pharmacol Ther</addtitle><description>Summary
Background
Recent longitudinal studies have emphasised the prognostic value of noninvasive tests of liver fibrosis and cross‐sectional studies have shown their combination significantly improves diagnostic accuracy.
Aim
To compare the prognostic accuracy of six blood fibrosis tests and liver biopsy, and evaluate if test combination improves the liver‐prognosis assessment in chronic hepatitis C (CHC).
Methods
A total of 373 patients with compensated CHC, liver biopsy (Metavir F) and blood tests targeting fibrosis (APRI, FIB4, Fibrotest, Hepascore, FibroMeter) or cirrhosis (CirrhoMeter) were included. Significant liver‐related events (SLRE) and liver‐related deaths were recorded during follow‐up (started the day of biopsy).
Results
During the median follow‐up of 9.5 years (3508 person‐years), 47 patients had a SLRE and 23 patients died from liver‐related causes. For the prediction of first SLRE, most blood tests allowed higher prognostication than Metavir F [Harrell C‐index: 0.811 (95% CI: 0.751–0.868)] with a significant increase for FIB4: 0.879 [0.832–0.919] (P = 0.002), FibroMeter: 0.870 [0.812–0.922] (P = 0.005) and APRI: 0.861 [0.813–0.902] (P = 0.039). Multivariate analysis identified FibroMeter, CirrhoMeter and sustained viral response as independent predictors of first SLRE. CirrhoMeter was the only independent predictor of liver‐related death. The combination of FibroMeter and CirrhoMeter classifications into a new FM/CM classification improved the liver‐prognosis assessment compared to Metavir F staging or single tests by identifying five subgroups of patients with significantly different prognoses.
Conclusions
Some blood fibrosis tests are more accurate than liver biopsy for determining liver prognosis in CHC. A new combination of two complementary blood tests, one targeted for fibrosis and the other for cirrhosis, optimises assessment of liver‐prognosis.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Biopsy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hematologic Tests</subject><subject>Hepatitis C virus</subject><subject>Hepatitis C, Chronic - blood</subject><subject>Hepatitis C, Chronic - diagnosis</subject><subject>Hepatitis C, Chronic - epidemiology</subject><subject>Hepatitis C, Chronic - pathology</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Life Sciences</subject><subject>Liver Cirrhosis - blood</subject><subject>Liver Cirrhosis - diagnosis</subject><subject>Liver Cirrhosis - epidemiology</subject><subject>Liver Cirrhosis - pathology</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Other diseases. Semiology</subject><subject>Pharmaceutical sciences</subject><subject>Prognosis</subject><subject>Viral diseases</subject><subject>Viral hepatitis</subject><issn>0269-2813</issn><issn>1365-2036</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqN0b1uFDEQAGALgcgRKHgB5AYJik38tz8uTycgSCdBEWrLa4-zRrv2Ye8dSkdDzzPyJPiyR1Ih4cby6PPMaAahl5Rc0HIu9W6-oKyj_BFaUd7UFSO8eYxWhDWyOsbP0LOcvxJCmpawp-iMia6TtZQr9HMTp94HPfsYcHS4H2O0eIY8Z-xiwtnfBO-80WHGzvcpZp-xDhYbn9Jw9_LTLsUDZDwPgHXOkPMEhZdsoz9A-v3jVwE3YcEBmyHF4A0eYFfKziW4eY6eOD1meHG6z9GX9--uN1fV9tOHj5v1tjI1a3kFou4psdKxpqdWgDRcUGY4SGKskVI3shaWWKCy1tRyDcJpaDtaiBaW8nP0dsk76FHtkp90ulVRe3W13qpjjFDeyfL7cLRvFlua_7YvA1GTzwbGUQeI-6xoXdOGScK7_6BcioZL3j50YMoocwJ33wYl6rhMVZap7pZZ7KtT2n0_gb2Xf7dXwOsT0Nno0SUdjM8PritTEy0p7nJx3_0It_-uqNafr5fSfwDo3riQ</recordid><startdate>201407</startdate><enddate>201407</enddate><creator>Boursier, J.</creator><creator>Brochard, C.</creator><creator>Bertrais, S.</creator><creator>Michalak, S.</creator><creator>Gallois, Y.</creator><creator>Fouchard‐Hubert, I.</creator><creator>Oberti, F.</creator><creator>Rousselet, M.‐C.</creator><creator>Calès, P.</creator><general>Blackwell</general><general>Wiley</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7U9</scope><scope>H94</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0001-7388-0916</orcidid><orcidid>https://orcid.org/0000-0003-4866-5274</orcidid></search><sort><creationdate>201407</creationdate><title>Combination of blood tests for significant fibrosis and cirrhosis improves the assessment of liver‐prognosis in chronic hepatitis C</title><author>Boursier, J. ; Brochard, C. ; Bertrais, S. ; Michalak, S. ; Gallois, Y. ; Fouchard‐Hubert, I. ; Oberti, F. ; Rousselet, M.‐C. ; Calès, P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5273-e45b10d9f26b1d4e9c3412c3e90cdc99a6954d0de195a1d3ae4fae781c3ea4d13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Biopsy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Hematologic Tests</topic><topic>Hepatitis C virus</topic><topic>Hepatitis C, Chronic - blood</topic><topic>Hepatitis C, Chronic - diagnosis</topic><topic>Hepatitis C, Chronic - epidemiology</topic><topic>Hepatitis C, Chronic - pathology</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Life Sciences</topic><topic>Liver Cirrhosis - blood</topic><topic>Liver Cirrhosis - diagnosis</topic><topic>Liver Cirrhosis - epidemiology</topic><topic>Liver Cirrhosis - pathology</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Other diseases. Semiology</topic><topic>Pharmaceutical sciences</topic><topic>Prognosis</topic><topic>Viral diseases</topic><topic>Viral hepatitis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boursier, J.</creatorcontrib><creatorcontrib>Brochard, C.</creatorcontrib><creatorcontrib>Bertrais, S.</creatorcontrib><creatorcontrib>Michalak, S.</creatorcontrib><creatorcontrib>Gallois, Y.</creatorcontrib><creatorcontrib>Fouchard‐Hubert, I.</creatorcontrib><creatorcontrib>Oberti, F.</creatorcontrib><creatorcontrib>Rousselet, M.‐C.</creatorcontrib><creatorcontrib>Calès, P.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Alimentary pharmacology & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boursier, J.</au><au>Brochard, C.</au><au>Bertrais, S.</au><au>Michalak, S.</au><au>Gallois, Y.</au><au>Fouchard‐Hubert, I.</au><au>Oberti, F.</au><au>Rousselet, M.‐C.</au><au>Calès, P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Combination of blood tests for significant fibrosis and cirrhosis improves the assessment of liver‐prognosis in chronic hepatitis C</atitle><jtitle>Alimentary pharmacology & therapeutics</jtitle><addtitle>Aliment Pharmacol Ther</addtitle><date>2014-07</date><risdate>2014</risdate><volume>40</volume><issue>2</issue><spage>178</spage><epage>188</epage><pages>178-188</pages><issn>0269-2813</issn><eissn>1365-2036</eissn><abstract>Summary
Background
Recent longitudinal studies have emphasised the prognostic value of noninvasive tests of liver fibrosis and cross‐sectional studies have shown their combination significantly improves diagnostic accuracy.
Aim
To compare the prognostic accuracy of six blood fibrosis tests and liver biopsy, and evaluate if test combination improves the liver‐prognosis assessment in chronic hepatitis C (CHC).
Methods
A total of 373 patients with compensated CHC, liver biopsy (Metavir F) and blood tests targeting fibrosis (APRI, FIB4, Fibrotest, Hepascore, FibroMeter) or cirrhosis (CirrhoMeter) were included. Significant liver‐related events (SLRE) and liver‐related deaths were recorded during follow‐up (started the day of biopsy).
Results
During the median follow‐up of 9.5 years (3508 person‐years), 47 patients had a SLRE and 23 patients died from liver‐related causes. For the prediction of first SLRE, most blood tests allowed higher prognostication than Metavir F [Harrell C‐index: 0.811 (95% CI: 0.751–0.868)] with a significant increase for FIB4: 0.879 [0.832–0.919] (P = 0.002), FibroMeter: 0.870 [0.812–0.922] (P = 0.005) and APRI: 0.861 [0.813–0.902] (P = 0.039). Multivariate analysis identified FibroMeter, CirrhoMeter and sustained viral response as independent predictors of first SLRE. CirrhoMeter was the only independent predictor of liver‐related death. The combination of FibroMeter and CirrhoMeter classifications into a new FM/CM classification improved the liver‐prognosis assessment compared to Metavir F staging or single tests by identifying five subgroups of patients with significantly different prognoses.
Conclusions
Some blood fibrosis tests are more accurate than liver biopsy for determining liver prognosis in CHC. A new combination of two complementary blood tests, one targeted for fibrosis and the other for cirrhosis, optimises assessment of liver‐prognosis.</abstract><cop>Oxford</cop><pub>Blackwell</pub><pmid>24889599</pmid><doi>10.1111/apt.12813</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-7388-0916</orcidid><orcidid>https://orcid.org/0000-0003-4866-5274</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Alimentary pharmacology & therapeutics, 2014-07, Vol.40 (2), p.178-188 |
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| language | eng |
| recordid | cdi_hal_primary_oai_HAL_hal_01389195v1 |
| source | Access via Wiley Online Library; MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Wiley Online Library (Open Access Collection) |
| subjects | Adult Biological and medical sciences Biopsy Female Follow-Up Studies Gastroenterology. Liver. Pancreas. Abdomen Hematologic Tests Hepatitis C virus Hepatitis C, Chronic - blood Hepatitis C, Chronic - diagnosis Hepatitis C, Chronic - epidemiology Hepatitis C, Chronic - pathology Human viral diseases Humans Infectious diseases Life Sciences Liver Cirrhosis - blood Liver Cirrhosis - diagnosis Liver Cirrhosis - epidemiology Liver Cirrhosis - pathology Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Middle Aged Other diseases. Semiology Pharmaceutical sciences Prognosis Viral diseases Viral hepatitis |
| title | Combination of blood tests for significant fibrosis and cirrhosis improves the assessment of liver‐prognosis in chronic hepatitis C |
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