Estudio retrospectivo de la capacidad de evaluación de fibrosis hepática del FibroScan ®, APRI, FIB-4 y FORNS con referencia a la biopsia hepática de pacientes con hepatitis crónica C, mono y coinfectados con VIH

Abstract

Objective To assess the ability of FibroScan ® (FS) and the APRI, FIB-4 and FORNS indexes to predict liver fibrosis (LF), using liver biopsy as the gold standard. Methods LF stage was determined in 154 patients with chronic hepatitis C virus infection using the METAVIR system. Fibroscan ® measurements and blood samples were taken simultaneously with biopsy. The tests were evaluated using ROC curves and the concordance, sensitivity, specificity and predictive values and likelihood ratios. Results Significantly higher LF stages were found in older patients and in those with HIV coinfection. FS and FIB-4 were able to predict significant LF≥1 and more than 94% of patients with FS>6.7 kPas or FIB-4>1.3 had LF≥1 in liver biopsy, with low sensitivities (63% FS; 56% Fib-4). For the detection of LF≥2, all the tests had significant predictive capacity and between 77% and 86% of the patients with FS>6.8kPas, APRI>0.6, FIB-4>1.4 and FORNS>5.6 had LF≥2, with low sensitivities (70%FS; 54%APRI; 59%FIB-4; 54%FORNS). All tests had high negative predictive values (91–92%) and specificities (86–92%) in the detection of advanced fibrosis (FH=4). Conclusion All tests were acceptable in predicting the presence or absence of mild fibrosis (LF≥2) and the absence of advanced fibrosis (LF=2). However, the low or moderate agreement with liver biopsy and low sensitivities in the detection of mild fibrosis indicate that liver biopsy continues to be required when the results of other methods are discordant or indeterminate.