Comparing the efficiency of Fib‐4, Egy‐score, APRI, and GUCI in liver fibrosis staging in Egyptians with chronic hepatitis C

Abstract

Assessment of hepatic fibrosis in chronic hepatitis C virus patients by liver biopsy is not widely accepted despite its accuracy, being invasive, carrying complications, and adding cost. This paved the way to development and use of non-invasive markers of fibrosis in diagnosis of hepatic fibrosis. We aimed at evaluating the efficiency of Fib-4, Egy-score, Aspartate-to-platelet ratio index (APRI), and Göteborg University Cirrhosis Index (GUCI) in comparison to liver biopsy, in the assessment of hepatic fibrosis in chronic hepatitis C patients. This was a cross sectional study including 200 chronic HCV patients were divided into two groups according to stage of fibrosis (Metavir score) into non-significant fibrosis (<F2) and significant fibrosis (≥F2). Reference needle liver biopsy was compared to Fib-4, Egyscore, APRI, and GUCI. Older age (P < 0.001) and higher BMI (P = 0.005) were significantly related to significant fibrosis and positively correlated with fibrosis progression (r = 0.361, P = 0.000, and r = 0.165, P = 0.019 respectively). Fib-4 >1.27, APRI >0.48, Egy-score >0.73, and GUCI >0.57 significantly predict significant fibrosis (P < 0.01). Fib-4 carries the best performance and significant reliability with AUROC 0.783, sensitivity 74%, specificity 69%, PPV 0.55, and NPV 0.86. The addition of BMI to Fib-4 improved the significant fibrosis AUROC curve performance but did not reach statistical significant improvement. We concluded that age and BMI are good predictors of hepatic fibrosis. Fib-4 (>1.27) is the best method of prediction of significant fibrosis compared to Egy-score, APRI, and GUCI. Addition of BMI to Fib-4 did not improve diagnostic value of Fib-4.

Predicting Liver Fibrosis in the Hepatitis C Population: Concordance Analysis Between Noninvasive Scoring Systems and Percutaneous Liver Biopsy

“…A single-center study helped minimize variations in inter-observer biopsy interpretation and avoided differences in processing in different labs. Other studies performed in other countries and a multi-center study in the USA have yielded similar results of AUROC for the FIB-4 index [ 9 - 14 ].…”

Liver Maximum Capacity: A Novel Test to Accurately Diagnose Different Stages of Liver Fibrosis

“…The correlation between enzymatic liver function measured by LiMAx ® and different stages of fibrosis was superior (Spearman's r = -0.68) when compared to validated [5,18,19,21,22,25,26,[44][45][46][47][48][49][50][51]. Transient elastography (TE) is probably the most validated method worldwide in the noninvasive assessment of liver fibrosis.…”

Dynamic Changes of the Aspartate Aminotransferase‐to‐Platelet Ratio and Transient Elastography in Predicting a Histologic Response in Patients With Chronic Hepatitis B After Entecavir Treatment

“…In addition to the liver stiffness value measured by FibroScan and AST‐to‐platelet ratio, several studies focused on other noninvasive methods for evaluating liver fibrosis in the CHB population, such as the fibrosis index based on 4 factors (age, platelet count, ALT, and AST) and the Forn index (a formula based on the platelet count, γ‐glutamyl transferase, age, and cholesterol). Both of them can detect liver fibrosis successfully . Considering the efficacy of those noninvasive methods, a study is needed to elucidate whether the combination of these potential candidates, such as the AST‐to‐platelet ratio and liver stiffness value, can better predict a histologic response.…”

“…Both of them can detect liver fibrosis successfully. [31][32][33] Considering the efficacy of those noninvasive methods, a study is needed to elucidate whether the combination of these potential candidates, such as the AST-to-platelet ratio and liver stiffness value, can better predict a histologic response.…”