Abstract
Chronic Hepatitis C Virus (HCV) infection leads to progressive fibrosis making fibrosis staging necessary in the evaluation of such patients. Different fibrosis scores are emerging as possible non-invasive alternatives for liver biopsy. The Fibrosis-4 Index (FIB-4) and AST to Platelet Ratio Index (APRI) scores are the most widely used and the most extensively tested. This study aims to determine if it was possible to accurately use these to identify patients that are unlikely to have severe fibrosis. One hundred and forty-two patients with chronic hepatitis C infection who underwent liver biopsy since January 1st 2014 until May 31st 2017 at the Hospital for Infectious and Tropical Diseases in Belgrade were analyzed. The FIB-4 and APRI scores were calculated for each patient and compared to histologically determined fibrosis stage. A comprehensive statistical analysis was conducted in order to compare patients with and without severe fibrosis and to evaluate the accuracy of the fibrosis scores. Patients with non-severe fibrosis were younger, had higher platelet counts and lower transaminase levels. FIB-4 had an AUC of 0.875 and the APRI score had an AUC of 0.861. No patients with severe fibrosis or cirrhosis had a FIB-4 lower than 1.08. FIB-4 was superior to APRI in identifying patients with severe fibrosis in the study cohort. FIB-4 was superior to APRI in the recognition of severe fibrosis. FIB-4 may prove very useful in identifying patients without advanced liver disease, especially if other non-invasive methods are inaccessible.
Highlights
Chronic Hepatitis C Virus (HCV) infection leads to progressive fibrosis making fibrosis staging necessary in the evaluation of such patients
According to the latest European Society for the Study of Liver (EASL) guidelines the stage of liver fibrosis can be determined by non-invasive methods during pretreatment evaluation with a prominent role for liver biopsy in cases where there is uncertainty regarding the stage of fibrosis or in cases in which comorbidities may affect the results of the non-invasive tests [3]
This study aims to determine which of the two aforementioned fibrosis scores is more accurate and whether it’s possible to use any single cut-off value of a fibrosis score to identify patients that are unlikely to have severe fibrosis or cirrhosis
Summary
Chronic Hepatitis C Virus (HCV) infection leads to progressive fibrosis making fibrosis staging necessary in the evaluation of such patients. A microscopic examination of liver tissue obtained via transcutaneous biopsy used to be considered the gold standard when it comes to assessing the stage of liver fibrosis in those with chronic hepatitis C, but experts have recently started advocating non-invasive methods for determining the stage of fibrosis [3]. A liver biopsy coupled with a histologic examination of the tissue sample is a relatively costly endeavor and requires significant human and technical resources making this aspect an even more realistic concern in low-income countries. With this in mind, many researchers have tried to find a feasible alternative to the liver biopsy as a means of staging fibrosis.
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