A prospective assessment of the inter-laboratory variability of biochemical markers of fibrosis (FibroTest) and activity (ActiTest) in patients with chronic liver disease
Identifieur interne : 000129 ( Pmc/Curation ); précédent : 000128; suivant : 000130A prospective assessment of the inter-laboratory variability of biochemical markers of fibrosis (FibroTest) and activity (ActiTest) in patients with chronic liver disease
Auteurs : Philippe Halfon [France] ; Françoise Imbert-Bismut [France] ; Djamila Messous [France] ; Gilles Antoniotti [France] ; Didier Benchetrit [France] ; Philippe Cart-Lamy [France] ; Gilles Delaporte [France] ; Danièle Doutheau [France] ; Théo Klump [France] ; Michel Sala [France] ; Didier Thibaud [France] ; Elisabeth Trepo [France] ; Dominique Thabut [France] ; Robert P. Myers [France] ; Thierry Poynard [France]Source :
- Comparative Hepatology [ 1476-5926 ] ; 2002.
Abstract
Biochemical markers for liver fibrosis (FibroTest) and necroinflammatory features (ActiTest) are an alternative to liver biopsy in patients with chronic hepatitis C. Our aim was to assess the inter-laboratory variability of these tests, and their 6 components (γ-glutamyl transpeptidase, alanine aminotransferase, α2-macroglobulin, haptoglobin, apolipoprotein A1, and total bilirubin) and to identify factors associated with this variability.
Serum of 24 patients with chronic hepatitis C or severe alcoholic liver disease were prospectively recorded and analyzed in one reference center and in 8 additional laboratories. When γ-glutamyl transpeptidase and alanine aminotransferase were expressed in international units, there was no significant difference between laboratories in the results of FibroTest or ActiTest; kappa statistics were greater than 0.50 with only 0.8% of cases (3/384) with a discordance of more than one stage. The main factor significantly associated with variability was the expression of γ-glutamyl transpeptidase and alanine aminotransferase, as multiples of upper limit of reference values. The use of standardized method with pyridoxal phosphate reduced the variability of alanine aminotransferase expression, and standardized original Szasz method reduced the variability of γ-glutamyl transpeptidase expression.
The variability of FibroTest and ActiTest was acceptable without clinical consequences for the prediction of the stage of liver fibrosis and grade of activity. Standardized methods and assay calibration should be used and expression of alanine aminotransferase and γ-glutamyl transpeptidase in multiples of the upper limit of reference values should not be employed.
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DOI: 10.1186/1476-5926-1-3
PubMed: 12537583
PubMed Central: 149429
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sort="Trepo, Elisabeth" uniqKey="Trepo E" first="Elisabeth" last="Trepo">Elisabeth Trepo</name><affiliation wicri:level="1"><nlm:aff id="I11">Centre de Biologie République, Centre de Biologie République, 42 Place de la République, 69002 Lyon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Centre de Biologie République, Centre de Biologie République, 42 Place de la République, 69002 Lyon</wicri:regionArea></affiliation></author><author><name sortKey="Thabut, Dominique" sort="Thabut, Dominique" uniqKey="Thabut D" first="Dominique" last="Thabut">Dominique Thabut</name><affiliation wicri:level="1"><nlm:aff id="I12">Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Université Paris 6 et UPRESA 8067 CNRS Paris, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Université Paris 6 et 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Myers</name><affiliation wicri:level="1"><nlm:aff id="I12">Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Université Paris 6 et UPRESA 8067 CNRS Paris, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Université Paris 6 et UPRESA 8067 CNRS Paris, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13</wicri:regionArea></affiliation></author><author><name sortKey="Poynard, Thierry" sort="Poynard, Thierry" uniqKey="Poynard T" first="Thierry" last="Poynard">Thierry Poynard</name><affiliation wicri:level="1"><nlm:aff id="I12">Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Université Paris 6 et UPRESA 8067 CNRS Paris, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Université Paris 6 et UPRESA 8067 CNRS Paris, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">12537583</idno><idno type="pmc">149429</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC149429</idno><idno type="RBID">PMC:149429</idno><idno type="doi">10.1186/1476-5926-1-3</idno><date when="2002">2002</date><idno type="wicri:Area/Pmc/Corpus">000131</idno><idno type="wicri:Area/Pmc/Curation">000129</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">A prospective assessment of the inter-laboratory variability of biochemical markers of fibrosis (FibroTest) and activity (ActiTest) in patients with chronic liver disease</title><author><name sortKey="Halfon, Philippe" sort="Halfon, Philippe" uniqKey="Halfon P" first="Philippe" last="Halfon">Philippe Halfon</name><affiliation wicri:level="1"><nlm:aff id="I1">Laboratoire Alphabio, 23 Rue de Friedland 13006 Marseille, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire Alphabio, 23 Rue de Friedland 13006 Marseille</wicri:regionArea></affiliation></author><author><name sortKey="Imbert Bismut, Francoise" sort="Imbert Bismut, Francoise" uniqKey="Imbert Bismut F" first="Françoise" last="Imbert-Bismut">Françoise Imbert-Bismut</name><affiliation wicri:level="1"><nlm:aff id="I2">Laboratoire de Biochimie, Groupe Hospitalier Pitié-Salpêtrière, 75651 Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire de Biochimie, Groupe Hospitalier Pitié-Salpêtrière, 75651 Paris</wicri:regionArea></affiliation></author><author><name sortKey="Messous, Djamila" sort="Messous, Djamila" uniqKey="Messous D" first="Djamila" last="Messous">Djamila Messous</name><affiliation wicri:level="1"><nlm:aff id="I2">Laboratoire de Biochimie, Groupe Hospitalier Pitié-Salpêtrière, 75651 Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire de Biochimie, Groupe Hospitalier Pitié-Salpêtrière, 75651 Paris</wicri:regionArea></affiliation></author><author><name sortKey="Antoniotti, Gilles" sort="Antoniotti, Gilles" uniqKey="Antoniotti G" first="Gilles" last="Antoniotti">Gilles Antoniotti</name><affiliation wicri:level="1"><nlm:aff id="I3">Laboratoire Biomedica, 7 Rue Davat, 73100 Aix les Bains, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire Biomedica, 7 Rue Davat, 73100 Aix les Bains</wicri:regionArea></affiliation></author><author><name sortKey="Benchetrit, Didier" sort="Benchetrit, Didier" uniqKey="Benchetrit D" first="Didier" last="Benchetrit">Didier Benchetrit</name><affiliation wicri:level="1"><nlm:aff id="I4">Laboratoire Barla, 10 Avenue Durante, 6000 Nice, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire Barla, 10 Avenue Durante, 6000 Nice</wicri:regionArea></affiliation></author><author><name sortKey="Cart Lamy, Philippe" sort="Cart Lamy, Philippe" uniqKey="Cart Lamy P" first="Philippe" last="Cart-Lamy">Philippe Cart-Lamy</name><affiliation wicri:level="1"><nlm:aff id="I5">Laboratoire Clinilab, 42 Avenue de la Plaine Fleurie, 38240 Meylan, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire Clinilab, 42 Avenue de la Plaine Fleurie, 38240 Meylan</wicri:regionArea></affiliation></author><author><name sortKey="Delaporte, Gilles" sort="Delaporte, Gilles" uniqKey="Delaporte G" first="Gilles" last="Delaporte">Gilles Delaporte</name><affiliation wicri:level="1"><nlm:aff id="I6">Laboratoire Delaporte, 37 Rue de la Marne BP 25, 45501 Gien, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire Delaporte, 37 Rue de la Marne BP 25, 45501 Gien</wicri:regionArea></affiliation></author><author><name sortKey="Doutheau, Daniele" sort="Doutheau, Daniele" uniqKey="Doutheau D" first="Danièle" last="Doutheau">Danièle Doutheau</name><affiliation wicri:level="1"><nlm:aff id="I7">Laboratoire Marcel Merieux, BP 7322, 69357 Lyon Cedex 07, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire Marcel Merieux, BP 7322, 69357 Lyon Cedex 07</wicri:regionArea></affiliation></author><author><name sortKey="Klump, Theo" sort="Klump, Theo" uniqKey="Klump T" first="Théo" last="Klump">Théo Klump</name><affiliation wicri:level="1"><nlm:aff id="I8">Laboratoire Klump, 1 Rue Kuhn, 67000 Strasbourg, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire Klump, 1 Rue Kuhn, 67000 Strasbourg</wicri:regionArea></affiliation></author><author><name sortKey="Sala, Michel" sort="Sala, Michel" uniqKey="Sala M" first="Michel" last="Sala">Michel Sala</name><affiliation wicri:level="1"><nlm:aff id="I9">Laboratoire Claude Levy, 78 Avenue de Verdun, 94200 Ivry-sur-Seine, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire Claude Levy, 78 Avenue de Verdun, 94200 Ivry-sur-Seine</wicri:regionArea></affiliation></author><author><name sortKey="Thibaud, Didier" sort="Thibaud, Didier" uniqKey="Thibaud D" first="Didier" last="Thibaud">Didier Thibaud</name><affiliation wicri:level="1"><nlm:aff id="I10">Laboratoire Sery, 4 Rue Gustave Cazavan, 76600 Le Havre, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Laboratoire Sery, 4 Rue Gustave Cazavan, 76600 Le Havre</wicri:regionArea></affiliation></author><author><name sortKey="Trepo, Elisabeth" sort="Trepo, Elisabeth" uniqKey="Trepo E" first="Elisabeth" last="Trepo">Elisabeth Trepo</name><affiliation wicri:level="1"><nlm:aff id="I11">Centre de Biologie République, Centre de Biologie République, 42 Place de la République, 69002 Lyon, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Centre de Biologie République, Centre de Biologie République, 42 Place de la République, 69002 Lyon</wicri:regionArea></affiliation></author><author><name sortKey="Thabut, Dominique" sort="Thabut, Dominique" uniqKey="Thabut D" first="Dominique" last="Thabut">Dominique Thabut</name><affiliation wicri:level="1"><nlm:aff id="I12">Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Université Paris 6 et UPRESA 8067 CNRS Paris, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Université Paris 6 et UPRESA 8067 CNRS Paris, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13</wicri:regionArea></affiliation></author><author><name sortKey="Myers, Robert P" sort="Myers, Robert P" uniqKey="Myers R" first="Robert P" last="Myers">Robert P. Myers</name><affiliation wicri:level="1"><nlm:aff id="I12">Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Université Paris 6 et UPRESA 8067 CNRS Paris, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Université Paris 6 et UPRESA 8067 CNRS Paris, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13</wicri:regionArea></affiliation></author><author><name sortKey="Poynard, Thierry" sort="Poynard, Thierry" uniqKey="Poynard T" first="Thierry" last="Poynard">Thierry Poynard</name><affiliation wicri:level="1"><nlm:aff id="I12">Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Université Paris 6 et UPRESA 8067 CNRS Paris, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Université Paris 6 et UPRESA 8067 CNRS Paris, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13</wicri:regionArea></affiliation></author></analytic><series><title level="j">Comparative Hepatology</title><idno type="eISSN">1476-5926</idno><imprint><date when="2002">2002</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Biochemical markers for liver fibrosis (FibroTest) and necroinflammatory features (ActiTest) are an alternative to liver biopsy in patients with chronic hepatitis C. Our aim was to assess the inter-laboratory variability of these tests, and their 6 components (γ-glutamyl transpeptidase, alanine aminotransferase, α<sub>2</sub>-macroglobulin, haptoglobin, apolipoprotein A1, and total bilirubin) and to identify factors associated with this variability.</p></sec><sec><title>Results</title><p>Serum of 24 patients with chronic hepatitis C or severe alcoholic liver disease were prospectively recorded and analyzed in one reference center and in 8 additional laboratories. When γ-glutamyl transpeptidase and alanine aminotransferase were expressed in international units, there was no significant difference between laboratories in the results of FibroTest or ActiTest; kappa statistics were greater than 0.50 with only 0.8% of cases (3/384) with a discordance of more than one stage. The main factor significantly associated with variability was the expression of γ-glutamyl transpeptidase and alanine aminotransferase, as multiples of upper limit of reference values. The use of standardized method with pyridoxal phosphate reduced the variability of alanine aminotransferase expression, and standardized original Szasz method reduced the variability of γ-glutamyl transpeptidase expression.</p></sec><sec><title>Conclusions</title><p>The variability of FibroTest and ActiTest was acceptable without clinical consequences for the prediction of the stage of liver fibrosis and grade of activity. Standardized methods and assay calibration should be used and expression of alanine aminotransferase and γ-glutamyl transpeptidase in multiples of the upper limit of reference values should not be employed.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Comp Hepatol</journal-id><journal-title>Comparative Hepatology</journal-title><issn pub-type="epub">1476-5926</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">12537583</article-id><article-id pub-id-type="pmc">149429</article-id><article-id pub-id-type="publisher-id">1476-5926-1-3</article-id><article-id pub-id-type="doi">10.1186/1476-5926-1-3</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>A prospective assessment of the inter-laboratory variability of biochemical markers of fibrosis (FibroTest) and activity (ActiTest) in patients with chronic liver disease</article-title></title-group><contrib-group><contrib id="A1" contrib-type="author"><name><surname>Halfon</surname><given-names>Philippe</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>philippe.halfon@alphabio.fr</email></contrib><contrib id="A2" contrib-type="author"><name><surname>Imbert-Bismut</surname><given-names>Françoise</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>francoise.bismut@psl.ap-hop-paris.fr</email></contrib><contrib id="A3" contrib-type="author"><name><surname>Messous</surname><given-names>Djamila</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>francoise.bismut@psl.ap-hop-paris.fr</email></contrib><contrib id="A4" contrib-type="author"><name><surname>Antoniotti</surname><given-names>Gilles</given-names></name><xref ref-type="aff" rid="I3">3</xref><email>lamanton@bio-medica.com</email></contrib><contrib id="A5" contrib-type="author"><name><surname>Benchetrit</surname><given-names>Didier</given-names></name><xref ref-type="aff" rid="I4">4</xref><email>d.benche@azurbio.org</email></contrib><contrib id="A6" contrib-type="author"><name><surname>Cart-Lamy</surname><given-names>Philippe</given-names></name><xref ref-type="aff" rid="I5">5</xref><email>cartlamy@aol.com</email></contrib><contrib id="A7" contrib-type="author"><name><surname>Delaporte</surname><given-names>Gilles</given-names></name><xref ref-type="aff" rid="I6">6</xref><email>labdelap45@aol.com</email></contrib><contrib id="A8" contrib-type="author"><name><surname>Doutheau</surname><given-names>Danièle</given-names></name><xref ref-type="aff" rid="I7">7</xref><email>tpoynard@teaser.fr</email></contrib><contrib id="A9" contrib-type="author"><name><surname>Klump</surname><given-names>Théo</given-names></name><xref ref-type="aff" rid="I8">8</xref><email>klumpp@noos.fr</email></contrib><contrib id="A10" contrib-type="author"><name><surname>Sala</surname><given-names>Michel</given-names></name><xref ref-type="aff" rid="I9">9</xref><email>m.sala@lablcl.com</email></contrib><contrib id="A11" contrib-type="author"><name><surname>Thibaud</surname><given-names>Didier</given-names></name><xref ref-type="aff" rid="I10">10</xref><email>d.thibaud@bioceane.fr</email></contrib><contrib id="A12" contrib-type="author"><name><surname>Trepo</surname><given-names>Elisabeth</given-names></name><xref ref-type="aff" rid="I11">11</xref><email>e.trepo@labo-republique.com</email></contrib><contrib id="A13" contrib-type="author"><name><surname>Thabut</surname><given-names>Dominique</given-names></name><xref ref-type="aff" rid="I12">12</xref><email>dthabut@libertysurf.fr</email></contrib><contrib id="A14" contrib-type="author"><name><surname>Myers</surname><given-names>Robert P</given-names></name><xref ref-type="aff" rid="I12">12</xref><email>drrobpmyers@hotmail.com</email></contrib><contrib id="A15" corresp="yes" contrib-type="author"><name><surname>Poynard</surname><given-names>Thierry</given-names></name><xref ref-type="aff" rid="I12">12</xref><email>tpoynard@teaser.fr</email></contrib></contrib-group><aff id="I1"><label>1</label>Laboratoire Alphabio, 23 Rue de Friedland 13006 Marseille, France</aff><aff id="I2"><label>2</label>Laboratoire de Biochimie, Groupe Hospitalier Pitié-Salpêtrière, 75651 Paris, France</aff><aff id="I3"><label>3</label>Laboratoire Biomedica, 7 Rue Davat, 73100 Aix les Bains, France</aff><aff id="I4"><label>4</label>Laboratoire Barla, 10 Avenue Durante, 6000 Nice, France</aff><aff id="I5"><label>5</label>Laboratoire Clinilab, 42 Avenue de la Plaine Fleurie, 38240 Meylan, France</aff><aff id="I6"><label>6</label>Laboratoire Delaporte, 37 Rue de la Marne BP 25, 45501 Gien, France</aff><aff id="I7"><label>7</label>Laboratoire Marcel Merieux, BP 7322, 69357 Lyon Cedex 07, France</aff><aff id="I8"><label>8</label>Laboratoire Klump, 1 Rue Kuhn, 67000 Strasbourg, France</aff><aff id="I9"><label>9</label>Laboratoire Claude Levy, 78 Avenue de Verdun, 94200 Ivry-sur-Seine, France</aff><aff id="I10"><label>10</label>Laboratoire Sery, 4 Rue Gustave Cazavan, 76600 Le Havre, France</aff><aff id="I11"><label>11</label>Centre de Biologie République, Centre de Biologie République, 42 Place de la République, 69002 Lyon, France</aff><aff id="I12"><label>12</label>Service d'Hépato-Gastroentérologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Université Paris 6 et UPRESA 8067 CNRS Paris, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France</aff><pub-date pub-type="collection"><year>2002</year></pub-date><pub-date pub-type="epub"><day>30</day><month>12</month><year>2002</year></pub-date><volume>1</volume><fpage>3</fpage><lpage>3</lpage><ext-link ext-link-type="uri" xlink:href="http://www.comparative-hepatology.com/content/1/1/3"></ext-link><history><date date-type="received"><day>24</day><month>9</month><year>2002</year></date><date date-type="accepted"><day>30</day><month>12</month><year>2002</year></date></history><permissions><copyright-statement>Copyright © 2002 Halfon et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.</copyright-statement><copyright-year>2002</copyright-year><copyright-holder>Halfon et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.</copyright-holder></permissions><abstract><sec><title>Background</title><p>Biochemical markers for liver fibrosis (FibroTest) and necroinflammatory features (ActiTest) are an alternative to liver biopsy in patients with chronic hepatitis C. Our aim was to assess the inter-laboratory variability of these tests, and their 6 components (γ-glutamyl transpeptidase, alanine aminotransferase, α<sub>2</sub>-macroglobulin, haptoglobin, apolipoprotein A1, and total bilirubin) and to identify factors associated with this variability.</p></sec><sec><title>Results</title><p>Serum of 24 patients with chronic hepatitis C or severe alcoholic liver disease were prospectively recorded and analyzed in one reference center and in 8 additional laboratories. When γ-glutamyl transpeptidase and alanine aminotransferase were expressed in international units, there was no significant difference between laboratories in the results of FibroTest or ActiTest; kappa statistics were greater than 0.50 with only 0.8% of cases (3/384) with a discordance of more than one stage. The main factor significantly associated with variability was the expression of γ-glutamyl transpeptidase and alanine aminotransferase, as multiples of upper limit of reference values. The use of standardized method with pyridoxal phosphate reduced the variability of alanine aminotransferase expression, and standardized original Szasz method reduced the variability of γ-glutamyl transpeptidase expression.</p></sec><sec><title>Conclusions</title><p>The variability of FibroTest and ActiTest was acceptable without clinical consequences for the prediction of the stage of liver fibrosis and grade of activity. Standardized methods and assay calibration should be used and expression of alanine aminotransferase and γ-glutamyl transpeptidase in multiples of the upper limit of reference values should not be employed.</p></sec></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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