Applicability of APRI and FIB-4 as a transition indicator of liver fibrosis in patients with chronic viral hepatitis

General evaluation score for predicting the development of hepatocellular carcinoma in patients with advanced liver fibrosis associated with hepatitis C virus genotype 1 or 2 after direct‐acting antiviral therapy

“…[36][37][38][39][40] In addition, FIB-4 index, which is a simple composite index, has been validated to be correlated with liver fibrosis in various studies of patients with chronic HCV infection, chronic hepatitis B virus infection, or nonalcoholic fatty liver disease, including nonalcoholic steatohepatitis. 31,41 FIB-4 index has been reported as a predictor of HCC development in patients with HCV who achieved SVR with antiviral therapy such as interferon or DAAs. 38,39 Hiraoka et al 26 developed the ADRES score as a composite model using clinical factors in 1069 patients with HCV who have received DAA therapy and achieved SVR in Japan.…”

“…The FIB-4 index cutoff values for F3 and F4 fibrosis were set to 3.26 and 3.61, respectively, based on a previous report. 31 HCC surveillance and diagnosis. Blood tests, including tests for tumor markers, and abdominal ultrasonography were carried out at the start of DAA treatment, SVR, and every 3-6 months thereafter for HCC surveillance.…”

“…In patients for whom liver biopsy data were not available, FIB‐4 index levels were used as the basis for diagnosing advanced liver fibrosis. The FIB‐4 index cutoff values for F3 and F4 fibrosis were set to 3.26 and 3.61, respectively, based on a previous report 31 …”

Development and multicenter validation of FIB‐6: A novel, machine learning, simple bedside score to rule out liver cirrhosis and compensated advanced chronic liver disease in patients with chronic hepatitis C

“…First, FIB-6 was developed using RF from a large biopsy proven data set; according to standards of study design, which is pivotal for evaluation of the accuracy of predictors, the validation set and the derivation dataset should be large 22 identified and externally validated a new cutoff for FIB-4 (≤0.70) that can be used to exclude cirrhosis. 24 Recently, Itakura and colleagues 10 used cutoff values of 0.77 for APRI and 3.26 for FIB-4 for the diagnosis of advanced fibrosis with accuracy rates of 73.2% and 75.0%, respectively. However, for diagnosis of cirrhosis, and using cutoff values of 0.78 for APRI and 3.61 for FIB-4, the accuracy was only 62.3% and 72.6% for APRI and FIB-4.…”

“…Moreover, application of these conventional cutoffs for the prediction of advanced fibrosis resulted in high rates of misclassification. [9][10][11] A recent study evaluated FIB-4 to assess liver cirrhosis among US veterans reported that the sensitivity of the FIB-4 score was unacceptably low for ruling out liver cirrhosis when using a binary cutoff at 3.25. 12 In addition, there were no cutoff values for ruling out cirrhosis (F4) alone, which is required for research studies or clinical trials for new therapies.…”