FIB-4, APRI, and AST/ALT ratio compared to FibroScan for the assessment of hepatic fibrosis in patients with non-alcoholic fatty liver disease in Bandar Abbas, Iran

Abstract

Background Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. Researchers have tried to develop indices to assess liver fibrosis in NAFLD patients to avoid liver biopsy. In this study we aimed to compare fibrosis-4 (FIB-4), aspartate aminotransferase (AST) to platelet ratio index (APRI), and aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio with FibroScan for the assessment of hepatic fibrosis in patients with NAFLD. Methods This cross-sectional study included patients with NAFLD or non-alcoholic steatohepatitis (NASH) referred to the Gastroenterology Clinic of Shahid Mohammadi Hospital, Bandar Abbas, Iran, in 2019. Demographic features of the participants including age and gender were recorded. All participants underwent FibroScan and had their AST, ALT, and platelet count measured in a random blood sample, taken within 1 month of the FibroScan. Results Of the 205 NAFLD patients included in this study with a mean age of 42.95 ± 10.97 years, 144 (70.2%) were male. Fibroscan results revealed that 94 patients (45.9%) had F1, 67 (32.7%) F2, 29 (14.1%) F3, and 15 (7.3%) F4 liver fibrosis. A significant correlation was found between FibroScan score and FIB-4 (r = 0.572), APRI (r = 0.667), and AST/ALT (r = 0.251) (P < 0.001). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of APRI at the 0.702 cut-off for the differentiation of F3 and F4 from F2 and F1 were 84.1, 88.2, 66.1, 95.3, and 87.3%, FIB-4 at the 1.19 cut-off 97.7, 72.7, 49.4, 99.2 and 78%, and AST/ALT at the 0.94 cut-off 61.4, 77, 42.2, 87.9, and 73.7% respectively. Moreover, the area under the receiver operating curve of APRI, FIB-4, and AST/ALT for the differentiation of F3 and F4 from F2 and F1 was 0.923, 0.913, and 0.720, respectively. Conclusions Based on these results, APRI appears to be the most appropriate substitute of FibroScan for the detection of significant fibrosis in NAFLD patients. FIB-4 was the second best, suggesting that in case of FibroScan unavailability, APRI and FIB-4 are the best indices to assess liver fibrosis in NAFLD patients.

The Role of Aspartate Transaminase to Platelet Ratio Index (APRI) for the Prediction of Non-Alcoholic Fatty Liver Disease (NAFLD) in Severely Obese Children and Adolescents

“…Among the different biomarkers proposed to be used for this purpose [2], in recent years, an increasing interest has been addressed regarding the aspartate transaminase to platelet ratio index (APRI), which has been investigated mainly in adult NAFLD and other chronic liver diseases, such as viral hepatitis [14][15][16][17][18]. When compared with liver biopsy and other non-invasive methods, APRI appeared to be a promising biomarker for assessing liver fibrosis/steatosis, with the advantages of being at low cost and repeatable [19].…”

Organophosphate pesticide exposure and biomarkers of liver injury/liver function

“…A greater increase in ALT than AST is probably related to hepatocyte injury, and AST/ALT ratio was useful for the diagnosis of liver injury or fibrosis 28 . FIB‐4 was well established as a non‐invasive marker of liver fibrosis at a point of diagnosis in cases with chronic liver disease 18,29 . In this study, except for the above biomarkers, we also included biomarkers for NAFLD including HSI and USFLI score, which were widely utilized to determine the presence of NAFLD in a non‐invasive manner.…”

“…28 FIB-4 was well established as a non-invasive marker of liver fibrosis at a point of diagnosis in cases with chronic liver disease. 18,29 In this study, except for the above biomarkers, we also included biomarkers for NAFLD including HSI and USFLI score, which were widely utilized to determine the presence of NAFLD in a non-invasive manner. Based on the above biomarkers, we observed significant association between OP metabolites and liver injury/liver function.…”

“…In our study, the fibrotic burden of the liver was evaluated using the fibrosis‐4 index (FIB‐4). FIB‐4 score was computed by the following formula: FIB‐4 = (age [years] × AST [U/L])/(platelet [10 9 /L] × (ALT [U/L]) 1/2 ) 18 . In addition to fibrosis, biomarkers for liver steatosis were also used as outcomes, given the potential associations between environmental chemicals and the prevalence of non‐alcoholic fatty liver disease (NAFLD) in our previous study 19 .…”

“…FIB-4 score was computed by the following formula: FIB-4 = (age [years] × AST [U/L])/ (platelet [10 9 /L] × (ALT [U/L]) 1/2 ). 18 In addition to fibrosis, biomarkers for liver steatosis were also used as outcomes, given the potential associations between environmental chemicals and the prevalence of non-alcoholic fatty liver disease (NAFLD) in our previous study. 19 Hepatic steatosis index (HSI) and US fatty liver index (USFLI) were used to assess the presence or absence of NAFLD in previous studies.…”