Fibrosis-4, aspartate transaminase-to-platelet ratio index, and gamma-glutamyl transpeptidase-to-platelet ratio for risk assessment of hepatocellular carcinoma in chronic hepatitis B patients: comparison with liver biopsy

Abstract

Background and aims: It is well known that hepatocellular carcinoma (HCC) develops as a consequence of hepatic fibrosis progression. Thus, early identification of advanced liver fibrosis is very important. This study evaluated the prognostic value of FIB-4, the aspartate transaminase to-platelet ratio index (APRI), and the gamma-glutamyl transpeptidase-toplatelet ratio (GPR) for predicting HCC development using histological fibrosis stage as a reference in Asian chronic hepatitis B (CHB) patients. Methods: A total of 444 CHB patients who underwent liver biopsy and serological tests for determining noninvasive serum fibrosis markers were enrolled. All patients were followed to monitor HCC development. Results: The histological fibrosis stage showed best performance in predicting HCC development at 5 (area under the receiver operating characteristic curve [AUROC] = 0.783) and 7 years (AUROC = 0.766), followed by FIB-4 (AUROC = 0.753 at 5 years, 0.698 at 7 years), APRI (AUROC = 0.658 at 5 years, 0.572 at 7 years), and GPR (AUROC = 0.638 at 5 years, 0.603 at 7 years). When we classified risk groups according to the histological fibrosis stage (F4 vs. F0-3) and FIB-4 (FIB-4 ≥ 3.25 vs. FIB-4 < 3.25), patients in the high-risk group were found to have a significantly higher probability of developing HCC than those in the low-risk group (P=0.005 and 0.022, respectively, log-rank test). Conclusion: Our study demonstrated that FIB-4 is useful for the noninvasive prediction of HCC development, while APRI and GPR were less useful.

Application of alkaline phosphatase‑to‑platelet ratio as a novel noninvasive index predicts liver fibrosis in patients with chronic hepatitis B

“…Similar to GGT, AKP is also a marker of liver fibrosis as part of the liver biochemical testing routine. As previously reported, non-invasive indices APRI, FIB-4 and GPR can be calculated using age, ALT, AST, GGT and PLT, all of which can be applied to predict fibrosis in patients with CHB (28). For this reason, it was hypothesized that the APPR may also be an useful index for distinguishing liver fibrosis from CHB.…”

On-Treatment Changes in FIB-4 and 1-Year FIB-4 Values Help Identify Patients with Chronic Hepatitis B Receiving Entecavir Therapy Who Have the Lowest Risk of Hepatocellular Carcinoma

“…The aminotransferase-to-platelet ratio index (APRI, Equation ( 1)) and fibrosis-4 (FIB-4, Equation ( 2)) index are popular noninvasive indices to predict liver fibrosis in chronic viral hepatitis [12][13][14]. Furthermore, baseline FIB-4 has a higher predictive performance for HCC than other indices in patients with CHB [15][16][17]. An Asian study reported that patients with noncirrhotic CHB receiving long-term NA therapy who had a FIB-4 < 1.29 at baseline had the lowest risk for HCC [18].…”

Gamma‐Glutamyl Transpeptidase‐to‐Platelet ratio predicts liver fibrosis in patients with concomitant chronic hepatitis B and nonalcoholic fatty liver disease

“… 24 FIB‐4 seems to be more useful than GPR and APRI in predicting the risk assessment of CHB‐induced HCC development. 29 …”

“…Dong et al suggested that HBeAg status should be taken into account when GPR was used to diagnose liver fibrosis and cirrhosis 24 . FIB‐4 seems to be more useful than GPR and APRI in predicting the risk assessment of CHB‐induced HCC development 29 …”