Fibrosis Index Based on 4 Factors (FIB-4) Predicts Liver Cirrhosis and Hepatocellular Carcinoma in Chronic Hepatitis C Virus (HCV) Patients

Abstract

BackgroundAlthough both hepatic fibrosis progression and hepatitis C virus (HCV) contribute to hepatocellular carcinoma (HCC) development, early detection of HCC remains challenging. Therefore, we evaluated clinical markers of fibrosis in HCV patients to improve early HCC diagnosis.Material/MethodsOur retrospective study included 711 chronic HCV patients: 249 HCC patients and 462 non-HCC patients. To investigate the predictive ability of non-invasive scores for diagnosing HCC development, we compared 4 blood indices: fibrosis index based on 4 factors (FIB-4), aspartate aminotransferase-to-platelet count ratio index (APRI), aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), and gamma-glutamyl transpeptidase-to-platelet count ratio (GPR).ResultsHCC patients had significantly higher scores for all fibrosis indices compared to chronic HCV patients without HCC. Moreover, the diagnostic performance of FIB-4 (area under curve, AUC: 0.961) was superior to that of APRI, AAR, and GPR (AUC: 0.636, 0.746, and 0.661, respectively) for prediction of HCC. FIB-4 also out-performed other indices in the prediction of cirrhotic cases, with an AUC of 0.775 compared to other scores, which ranged from an AUC of 0.597 to 0.671.ConclusionsTogether, these results suggest that FIB-4 is an appropriate diagnostic indicator of liver cirrhosis and HCC in chronic HCV patients in China.

Plasma interleukin-17 and alpha-fetoprotein combination effectively predicts imminent hepatocellular carcinoma occurrence in liver cirrhotic patients

“…Previously, non-invasive APRI and FIB-4 scores have been developed to indicate fibrosis stages, which naturally correlated with the HCC risks. More advanced stages correspond to higher HCC risks [5][6][7][8][9][10][11]. The current study addressed liver cirrhotic patients, corresponding to those in the stages 5 and 6 of the Ishak fibrosis staging system and stage 4 in the META-VIR staging system.…”

“…7 Tissue Bank, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan. 8 Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. 9 Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.…”

“…In the past, noninvasive scores such as fibrosis-4 (FIB-4), AST to Platelet Ratio Index (APRI) and gamma-glutamyl transpeptidase-to-platelet ratio have been developed to estimate the severity of fibrosis [3,4]. These scores were subsequently used for the prediction of HCC [5][6][7][8][9][10][11], based on the rationale that the severity of fibrosis correlates with HCC risks. Noninvasive liver stiffness measurements were also used for the prediction of HCC [12] and posttreatment prognosis [13].…”

Risk Factors and Prevention of Viral Hepatitis-Related Hepatocellular Carcinoma

“…FIB-4 over 2.18 can predict the occurrence of HCC in patients with HCV with a sensitivity of 92.4% and specificity of 87.2%. Compared with the APRI, FIB-4 has a higher diagnostic performance for predicting HCC caused by HCV infection ( 71 ).…”

Enhanced liver fibrosis score as a predictive marker for hepatocellular carcinoma development after hepatitis C virus eradication

“…Regarding the evaluation of fibrosis, non-invasive methods (serum markers or transient elastography) were recently adopted instead of invasive liver biopsy. Representative fibrosis markers include type IV collagen ( 8 ), Wisteria floribunda agglutinin-positive Mac-2-binding protein (M2BPGi) ( 9 ), and fibrosis-4 (FIB-4) index ( 10 , 11 ). On the other hand, an enhanced liver fibrosis (ELF) score composed of three liver fibrosis markers was developed to evaluate liver fibrosis ( 12 ).…”