Prospective comparison of transient elastography, point shear wave elastography, APRI and FIB‐4 for staging liver fibrosis in chronic viral hepatitis

Abstract

Ultrasound‐based elastography and serum indexes have been individually validated as noninvasive methods for staging liver fibrosis in chronic viral hepatitis. We aimed to compare the accuracy of transient elastography (TE), shear wave elastography (SWE), aspartate aminotransferase to platelet index (APRI) and Fibrosis‐4 index (FIB‐4) with the METAVIR liver fibrosis staging in viral hepatitis patients. We enrolled 121 treatment‐naïve chronic hepatitis B and C monoinfected patients. All underwent liver biopsy had biochemistry tests and liver stiffness measurements by TE using M and XL probes followed by point SWE performed on the same day. The accuracy of each method for predicting different fibrosis stages was demonstrated as an area under the receiver operating characteristic (AUROC) curves. The AUROCs of TE using M and XL probes, SWE, APRI and FIB‐4 were 0.771, 0.761, 0.700, 0.698 and 0.697, respectively, for significant fibrosis; 0.974, 0.973, 0.929, 0.738 and 0.859, respectively, for advanced fibrosis; and 0.954, 0.949, 0.962, 0.765 and 0.962, respectively, for cirrhosis. TE using the M probe was comparable to the XL probe in detecting all fibrosis stages. TE was superior to SWE for assessing significant fibrosis and advanced fibrosis. For cirrhosis, the performances of TE, SWE and FIB‐4 were similar. APRI was least accurate in liver fibrosis staging. To conclude, for patients with viral hepatitis, TE using either M or XL probe is an effective noninvasive test for assessing liver fibrosis, particularly advanced fibrosis and cirrhosis, while SWE and FIB‐4 possess an excellent accuracy in predicting cirrhosis.

Derivation and validation of prognostic models for predicting survival outcomes in Acute‐on‐chronic liver failure patients

“…13 Hyperglycaemia might increases risks of adverse outcome. APRI score was initially developed as a noninvasive model for fibrosis and cirrhosis diagnosis, 32,33 which has been shown to be useful for the assessment of advanced liver fibrosis in a variety of liver diseases, such as chronic viral hepatitis [33][34][35] and non-alcoholic fatty liver disease (NAFLD). 36 In an American study, APRI levels were associated with increased mortality from liver disease.…”

Liver function tests and fibrosis scores in a rural population in Africa: a cross-sectional study to estimate the burden of disease and associated risk factors

“…These HCV RNA-positive individuals have been described in more detail elsewhere. 30 We present results of multivariate analysis in the form of Forrest plots generated using Microsoft Excel v. 16.…”

“…[10][11][12][13][14][15] GPR has recently been reported as an independent predictor of significant fibrosis in naive Gambian patients with chronic hepatitis B (CHB) infection, 13 while the usefulness of cut-off values for APRI scores in CHB has been questioned. 16 However, further studies are needed to determine the specificity and sensitivity of different scores in different settings.…”

Comparison between shear wave elastography and serological findings for the evaluation of fibrosis in chronic liver disease

“…Several serological tests have been established to identify liver fibrosis. The aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 index (FIB-4) scoring are the most extensively used compound substitutes for detecting progressive fibrosis (16) . Uroš Karić et al concluded in their study that FIB-4 was superior to APRI in distinguishing severe fibrosis.…”