Evaluation of APRI and FIB-4 for noninvasive assessment of significant fibrosis and cirrhosis in HBeAg-negative CHB patients with ALT ≤ 2 ULN

Abstract

To evaluate the performance of aspartate transaminase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) to predict significant fibrosis and cirrhosis in hepatitis B virus e antigen (HBeAg)-negative chronic hepatitis B (CHB) patients with alanine transaminase (ALT) ≤ twice the upper limit of normal (2 ULN).Histologic and laboratory data of 236 HBeAg-negative CHB patients with ALT ≤ 2 ULN were analyzed. Predicted fibrosis stage, based on established scales and cut-offs for APRI and FIB-4, was compared with METAVIR scores obtained from liver biopsy.In this study, the areas under the receiver operating characteristic curves (AUROCs) of APRI were lower than that of FIB-4 (0.62 vs 0.69; P = 0.019) for diagnosing significant fibrosis; however APRI and FIB-4 were comparable for diagnosing cirrhosis (0.77 vs 0.81; P = 0.374). When the cut-off proposed by WHO HBV guideline for APRI (>2.0) was used, no cirrhotic patients were correctly predicted. For FIB-4, the WHO proposed cut-off of 3.25 correctly identified significant fibrosis 83% of the time; but for APRI, the WHO proposed cut-off of 1.5 identified significant fibrosis 56%. In ruling out significant fibrosis, the WHO proposed APRI cut-off of 0.5 had a predictive value of 39%, and the FIB-4 cut-off of 1.45 correctly identified lack of significant fibrosis in 47% of the patients. In this study, based on ROC analysis, the optimal cut-offs were 0.46 and 0.65 for APRI, and 1.05 and 1.29 for FIB-4, for diagnosing significant fibrosis and cirrhosis, respectively. When the new cut-off of APRI (>0.65) was used, 82% of the cirrhotic patients were correctly predicted. In ruling out significant fibrosis, the new APRI cut-off (<0.46) had a predictive value of 80%, and new FIB-4 cut-off (<1.05) correctly identified lack of significant fibrosis in 84% of the patients.The WHO guidelines proposed cut-offs might be higher for HBeAg-negative CHB patients with ALT ≤2 ULN, and might underestimate the proportion of significant fibrosis and cirrhosis. A new set of cut-offs should be used to predict significant fibrosis and cirrhosis in this specific population.

Validation and comparison of seventeen noninvasive models for evaluating liver fibrosis in Chinese hepatitis B patients

“…The optimal cut‐off values of these noninvasive models discriminating different fibrosis stages were determined by Youden Index and presented in Table , along with corresponding sensitivities, specificities, PPVs and NPVs. Comparing most of the optimal cut‐off values derived from our data with those published before, differences existed.…”

“…Some of these noninvasive models have been validated in CHB cohorts, for instance, Desalegn and colleagues did validation on APRI in a CHB cohort in sub‐Saharan Africa, reporting the AUROCs for diagnosing SF and cirrhosis being 0.79 and 0.86 . Nevertheless, comparing with CHC cohorts, data of validation in CHB cohorts were insufficient and diagnostic accuracies of these noninvasive models varied among studies, let alone some of the models, such as fibrosis cirrhosis index (FCI), fibrosis index (FI), Doha score and Virahep‐C model, have not been validated in CHB patients yet. Hence, to comprehensively evaluate diagnostic accuracies of these noninvasive models, more studies on validation in CHB patients, especially those in large cohorts, were imperative.…”

Combining GP73 with liver stiffness measurements: A proof‐of‐concept for non‐invasive fibrosis assessment in antiviral‐naïve HBV patients

“…11 A recent retrospective study that analysed HBeAg-negative HBV patients with ALT levels ≤2 of the upper limit of normal highlighted that conventional scores like FIB-4 and APRI might underestimate the proportion of significant fibrosis and cirrhosis, if the cut-off values are not adjusted to the specific characteristics of the patients (eg HBeAg-negative, normal/mildly elevated ALT). 12 Although most of these algorithms are more effective in detecting significant fibrosis than tests that are based on individual measurements, they do not necessarily increase diagnostic accuracy for cirrhosis. 2 The incorporation of serum GP73 as a biomarker might have the potential to overcome this limitation.…”

“…Nonetheless, APRI and FIB‐4 scores have significant pitfalls in clinical practice for the assessment of fibrosis, as demonstrated by a study that focused on patients with more advanced disease (97% fibrosis stage ≥2, and 24% had cirrhosis) and a substantial proportion of patients with ALT above twice the upper limit of normal . A recent retrospective study that analysed HBeAg‐negative HBV patients with ALT levels ≤2 of the upper limit of normal highlighted that conventional scores like FIB‐4 and APRI might underestimate the proportion of significant fibrosis and cirrhosis, if the cut‐off values are not adjusted to the specific characteristics of the patients (eg HBeAg‐negative, normal/mildly elevated ALT) …”

Avaliação assistencial da população atendida no ambulatório A2MG404 (Hepatite B) da Divisão de Gastroenterologia e Hepatologia Clínica do HC-FMUSP

“…Entretanto, sua utilização e confiabilidade para predizer fibrose nos pacientes infectados por HBV é assunto amplamente discutido na literatura científica. Alguns autores opõem-se à utilizado do APRI nesses casos107,108 ; enquanto outros defendem a sua utilização[109][110][111][112][113][114][115][116] . Com os dados obtidos neste trabalho não foi possível aderir à um posicionamento ou outro em relação à utilização do APRI para predizer fibrose hepática, uma vez que dados de exames de imagem, como ultrassonografias não foram coletados.…”