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BioMed Research International
Volume 2017 (2017), Article ID 8252980, 8 pages
Research Article

Latent Class Analysis of Noninvasive Methods and Liver Biopsy in Chronic Hepatitis C: An Approach without a Gold Standard

1Gastroenterology and Hepatology Department, University of the State of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
2Gastroenterology and Hepatology Department, Bonsucesso Federal Hospital, Rio de Janeiro, RJ, Brazil
3Laboratory of Clinical Research in HIV, AIDS and STD (LAPCLIN-AIDS), National Institute of Infectious Diseases Evandro Chagas (INI), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
4Rheumatology Department, Federal University of São Paulo, São Paulo, SP, Brazil
5Department of Research and Development, Fleury Group, São Paulo, SP, Brazil
6Gastroenterology Department, Federal University of São Paulo, São Paulo, SP, Brazil
7D’Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil

Correspondence should be addressed to Hugo Perazzo; rb.zurcoif.ini@ozzarep.oguh

Received 31 March 2017; Revised 30 July 2017; Accepted 3 August 2017; Published 13 September 2017

Academic Editor: Paola Di Carlo

Copyright © 2017 Flavia F. Fernandes et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Aims. To evaluate the applicability of the Latent Class Analysis (LCA) and accuracy of transient elastography (TE), aspartate-to-platelet-ratio-index (APRI), enhanced liver fibrosis (ELF), and liver biopsy (LB) for liver fibrosis assessment in a model without a gold standard. Methods. Significant fibrosis was defined as  kPa, , , or LB METAVIR . Cirrhosis was defined as  kPa, , , or LB as METAVIR . Results. 117 patients with chronic hepatitis C were included. In the LCA, for significant fibrosis the sensitivities and specificities (95% CI) were 0.92 (0.86–0.98) and 0.79 (0.72–0.86) for TE; 0.47 (0.40–0.54) and 0.99 (0.95–1.00) for APRI; 0.81 (0.74–0.88) and 0.78 (0.71–0.85) for ELF; and 0.86 (0.68–1.00) and 0.91 (0.79–1.00) for LB. For cirrhosis, the sensitivities and specificities were 0.92 (0.76–1.00) and 0.94 (0.91–0.97) for TE; 0.57 (0.37–0.77) and 0.97 (0.93–1.00) for APRI; 0.94 (0.84–1.00) and 0.88 (0.82–0.94) for ELF; and 0.30 (0.12–0.48) and 1.00 for LB. Conclusion. LCA was useful to evaluate accuracy of methods for liver fibrosis staging. Sensitivities and specificities of noninvasive methods were increased in LCA compared to the use of LB as the gold standard.