Fibrosis scores that can be used in follow-up of after direct-acting antiviral treatment: APRI, FIB-4, King score and GUCI

Abstract

Introduction Sustained virologic response in the treatment of chronic hepatitis C can be achieved with direct-acting antivirals (DAA) in recent years. Monitoring virologic and histologic response to treatment is essential and noninvasive methods are preferred. In our study, we aimed to determine the regression of fibrosis following DAA treatment with serum fibrosis indices constituting a noninvasive method. Method Patients with chronic hepatitis C to whom DAA treatment is started between January 2016 and January 2018 in our clinic are evaluated retrospectively. The fibrosis scores [fibrosis 4 index (FIB-4), aminotransferase platelet ratio (APRI), Fibro QKing score, age platelet index, Goteburg University Cirrhosis Index (GUCI), aspartate transaminase/alanine transaminase ratio (AAR)] are calculated with routine biochemical and hematologic tests of DAA-treated patients before treatment, at the end of treatment, and in the 12th and 24th weeks of treatment. In total, the course of seven scores calculated at four separate times including baseline was recorded and compared. Results In total 91 patients are included in the study. The average age was 51.16 ± 13.78 and 59.3% (n = 54) of patients were women. According to the baseline FIB-4 values, the patients were grouped as cirrhotic or noncirrhotic, and 11 of them were cirrhotic (12.1%). Statistically significant regression in APRI, FIB-4, GUCI and King scores is seen in all groups regardless of their cirrhotic status, treatment experience or genotype (P < 0.001). Specified scores had a positive, significant correlation with pretreatment biopsy results [area under curve (AUC): 0.800, 0.782, 0.749 and 0.746]. Conclusion: APRI, FIB-4, GUCI and King scores that have a positive correlation with biopsy can also be used for fibrosis recovery follow-up after treatment with DAAs.

Investigation of liver fibrosis with serum biochemical parameters before treatment with direct-acting antivirals, at the end of treatment, and in the first and third year after treatment in patients with chronic hepatitis C

“…Chronic hepatitis C and liver fibrosis the curve (AUC): 0.800 and 0.782] [9]. In our study, the highest value of area under the curve (AUC) in the ROC analysis performed for the cut-off point to predict the presence of histological fibrosis was calculated with the FIB-4 scoring (AUC: 0.763).…”

“…In another study, a statistically significant decrease in APRI and FIB-4 scores was observed at the end of treatment, and at the 12 th and 24 th weeks after treatment compared to before treatment with DAA. A significant positive correlation was found between scores and biopsy results before treatment [area under the curve (AUC): 0.800 and 0.782] [ 9 ]. In our study, the highest value of area under the curve (AUC) in the ROC analysis performed for the cut-off point to predict the presence of histological fibrosis was calculated with the FIB-4 scoring (AUC: 0.763).…”

Non-invasive Fibrosis Markers for Predicting Esophageal Varices: A Potential Alternative to Endoscopic Screening

“…A research study completed between January 2016 and January 2018 reported that 91 subjects with hepatitis C had their liver biopsies done and, afterward, had their AAR, FIB-4, Göteborg University Cirrhosis Index (GUCI), and King’s scores measured. They showed a positive correlation with the histological findings and had a significant value of less than 0.001 [ 25 ]. However, in another study, patients to whom antiviral therapy was administered did not show very efficacious results nor a correlation between FIB-4 and APRI with a degree of fibrosis regression after therapy [ 26 ].…”

Regression in hepatic fibrosis in elderly Chinese patients with hepatitis C receiving direct-acting antiviral treatment

“…Although liver biopsy is recommended prior to antiviral treatment, it may cause complications and is limited by relatively high costs, meaning it is not typically used in the routine management of CHC patients receiving DAAs. To replace biopsy, several noninvasive tests have been created, which are reproducible, and validated in several published studies [ 35 , 36 ]. Accordingly, we applied TE to measure LSM, and GPR, FIB-4, and APRI scores to evaluate the degree of liver fibrosis.…”