Liver fibrosis staging with combination of APRI and FIB-4 scoring systems in chronic hepatitis C as an alternative to transient elastography

Abstract

Background: Liver disease severity must be determined before treatment of chronic hepatitis C (CHC). We evaluated the diagnostic performance of the APRI and FIB-4 scores compared to transient elastography liver stiffness (TE-LS) in detecting significant fibrosis (F3) or cirrhosis (F4). Methods: We retrospectively enrolled 575 patients with CHC who underwent TE-LS between May 2014 and September 2018: 365 (63.5%) male, mean age 51.54±12.4 years. APRI and FIB-4 scores were compared to TE-LS. Results : One hundred patients (17.5%) had TE-LS values between 9 and 11.9 kPa, and were classified as F3, while 265 (46%) were classified as F4 (TE-LS ≥12 kPa). APRI and FIB-4 scores predicted F4 patients adequately using cutoff values of 0.65 (sensitivity 85.5%, specificity 77%) and 1.63 (sensitivity 91%, specificity 77%), respectively. Cutoff values of 0.64 for APRI and 1.46 for FIB-4 predicted F3/F4 patients (sensitivity 72% and 81.5%; specificity 83% and 79%, respectively). The use of these cutoff values with APRI and FIB-4 in combination adequately predicted patients with significant fibrosis or cirrhosis (positive predictive value 91.5%), while cutoff values of 0.3 and 0.98, respectively, predicted F1/F2 patients with specificity 94.5% and sensitivity 26.5%, suggesting that in 58.5% of patients TE-LS could possibly be avoided. Conclusions: The APRI/FIB-4 combination performed well in predicting significant fibrosis, while FIB-4 performed well in predicting cirrhosis. These noninvasive biochemical markers could be used as screening tools instead of LS measurement, which is not widely available. Further prospective validation studies are required to confirm this finding.

Chronic hepatitis C treatment in HIV co‐infection in Portugal: Results from a cohort OF 2133 patients presented by GEPCOI (Portuguese Coinfection Study Group)

“…Liver cirrhosis was considered when patients had a fibroscan score (FS) above 12.5 KPa or when having an APRI score above 1.0 and a FIB‐4 score above 3.25 . Multivariate logistic regression was used to determine whether there were any correlations between SVR and those independent variables with significant differences ( P < .05) and of clinical interest.…”

A genomic variant of ALPK2 is associated with increased liver fibrosis risk in HIV/HCV coinfected women

“…The utility of these surrogate fibrosis metrics has been validated against biopsy and other measures (i.e. transient elastography) in previous studies [ 43 ], but were not validated by such methods at present.…”

Three-dimensional CT texture analysis of anatomic liver segments can differentiate between low-grade and high-grade fibrosis

“…SWE has been extensively validated and recognized as an accurate technique for staging liver fibrosis [ 10 , 23 ]. Thus, similar to other studies, we used ultrasound elastography for the assessment of advanced-stage fibrosis instead of liver biopsy [ 24 , 25 ]. Imaging in PV is routinely performed during most of the abdominal CT scans.…”