Diagnostic accuracy studies of at least 30 patients, systematic reviews or meta-analyses, which assessed panels of at least two serum markers, used liver biopsy as the reference standard and reported data separately for interferon-naive patients with CHC, were eligible for inclusion. Studies that did not produce a composite score based on the serum markers were excluded. Serum markers were defined as any measure that could be derived from a blood sample. The included studies assessed ten different panels of serum markers; full details were given. Different systems were used to stage fibrosis based on the liver biopsy result.
The median age of the included patients was 44.5 years (range: 39 to 47) and the median proportion of men was 64% (range: 45 to 71). Four studies prevented CHC risk factors. The proportion of patients with moderate or severe fibrosis was 43% (range: 17 to 80).
The outcomes reported in the review were the area under the receiver operating curve (AUC), sensitivity, specificity, predictive values, positive and negative likelihood ratios (LR+ and LR-, respectively), and diagnostic odds ratios (DORs).
The included studies used either prospective or retrospective diagnostic cohort designs. Some studies used two cohorts of patients: a training set and a validation set, recruited either from the same or different centres.
Two reviewers assessed studies for inclusion.