A Comparative Analysis of the APRI, FIB4, and FibroScan Score in Evaluating the Severity of Chronic Liver Disease in Chronic Hepatitis B Patients in India.

Sumit Rungta,Ghulam Akhtar,Shweta Kumari,Kamlendra Verma,Amar Deep,Suchit Swaroop

doi:10.7759/cureus.19342

Abstract

Background and aimsNon-invasive assessment methods to assess liver fibrosis are important tools where FibroScan or liver biopsy is not accessible. The aim of this study is to assess the efficacy and performance of the fibrosis index based on four factors (FIB-4) and aspartate transaminase-to-platelet ratio index (APRI) to evaluate liver fibrosis against FibroScan for the stages of liver fibrosis in patients of chronic liver disease due to chronic hepatitis B (CHB).MethodsThis was a cross-sectional study conducted in a tertiary care center in Uttar Pradesh, India, and the patients were enrolled between 2017 and 2020. During the study period, 520 patients with a confirmed diagnosis of chronic hepatitis B virus (HBV) infection were selected. Laboratory blood testing and FibroScan were performed in all patients with CHB. APRI and FIB-4 were calculated using a standard formula involving laboratory parameters.ResultThe performance of FIB-4 scores are nearly similar to APRI, with area under the curve (AUC) 0.753, (95% CI) (0.711-0.795) (p<0.0001) for ≥F2 fibrosis (significant fibrosis) and even better 0.851 (0.815-0.887) (p<0.0001) for the F4 fibrosis (cirrhosis) group. Both the tests are proven good to diagnose fibrosis but FIB-4 has more area under the receiver operating characteristic (AUROC) than APRI in each set, thus FIB-4 is considered better than APRI.ConclusionsAPRI and FIB-4 scores showed good performance in detecting patients without liver fibrosis as compared with FibroScan. Based on this study, FibroScan can be avoided in patients examined for the diagnosis of mild fibrosis and cirrhosis in the source constrained area.

Highlights

Hepatitis B virus (HBV) is an infectious agent that infects the human liver cells and causes liver inflammation, which leads to chronic infection and severe problems such as liver cirrhosis (LC) or hepatocellular carcinoma (HCC) more frequently than the other types of hepatitis viruses
The aim of this study is to assess the efficacy and performance of the fibrosis index based on four factors (FIB-4) and aspartate transaminase-to-platelet ratio index (APRI) to evaluate liver fibrosis against FibroScan for the stages of liver fibrosis in patients of chronic liver disease due to chronic hepatitis B (CHB)
Categories: Gastroenterology, Infectious Disease, Epidemiology/Public Health Keywords: cirrhosis, fibrosis, fibrosis index based on four factors, chronic hepatitis b, aspartate transaminase-to-platelet ratio index

Summary

Introduction

Hepatitis B virus (HBV) is an infectious agent that infects the human liver cells and causes liver inflammation, which leads to chronic infection and severe problems such as liver cirrhosis (LC) or hepatocellular carcinoma (HCC) more frequently than the other types of hepatitis viruses. HBV positivity in the Indian population ranges from 1.1% to 12.2% and based on some regional level studies, it is estimated that in India, about 40 million people are chronically infected with the hepatitis B virus [4]. Persistent viral replication leads to continuous necroinflammation and patients are at higher risk of cirrhosis, end-stage liver disease, hepatic decompensation, and hepatocellular carcinoma (HCC) [5]. In patients with CHB, the accurate stage of hepatic fibrosis is the most important predictor of. The aim of this study is to assess the efficacy and performance of the fibrosis index based on four factors (FIB-4) and aspartate transaminase-to-platelet ratio index (APRI) to evaluate liver fibrosis against FibroScan for the stages of liver fibrosis in patients of chronic liver disease due to chronic hepatitis B (CHB)

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