FIB-4, APRI, and AST/ALT Ratio in Comparison to Transient Elastography (TE, Fibroscan) in the Assessment of Significant Liver Fibrosis in Patients With Chronic Hepatitis B (CHB)

Abstract

Introduction: Chronic hepatitis B is a predominant cause of chronic liver disease and liver related- morbidity worldwide. Transient elastography (TE, Fibroscan) along with serum tests like Fibrosis-4 index (FIB-4), aspartate transaminase to platelet ratio index (APRI) and aspartate transaminase to alanine transaminase ratio (AST/ALT) are useful ways of detecting fibrosis in the liver of patients with chronic Hepatitis B. Our aim in our study is to compare Fibroscan (TE) to serums test in the assessment of significant fibrosis in the liver. Methods: This is a cross-sectional retrospective study which included 262 patients with CHB who had a Fibroscan between March 2014 through March 2017. Patients were divided based on liver stiffness measurement (LSM) into non significant fibrosis F0-F1 (Kpa <7.2) and significant fibrosis F2-F4 (kpa>7.2). Statistical analysis was performed using SPSS 21. Data were expressed as mean ± standard deviation. The correlation between non-invasive tests and transient elastography was tested using the nonparametric Spearman's correlation coefficient. Areas under the receiver operating characteristics curves (AUROC) and the 95% confidence intervals (CI) of the AUROC values were calculated for detection of significant fibrosis. Results: The mean age for CHB patients was 43 with male predominance (56%) and asian ethnicity (55%). 92 (35%) patients did not receive treatment and 44 (17%) patients had a viral load more than 2000 with a mean of 259408. Area under the ROC curve (AUROC) of FIB4, APRI and AST/ALT were 0.715, 0.726 and 0.429 for the significant fibrosis (according to 7.2 kPa). FIB-4 correlated significantly with fibroscan score (r=0.346, p<0.0001) but APRI and AST/ALT ratio did not correlate (r=0.104, p=1.04; r=0.023, p=0.717), AUROCs of FIB-4, APRI, AST/ALT ratio were 0.688, 0.644 and 0.470 for significant fibrosis (kpa >7.2). FIB4 and APRI had a higher accuracy for the prediction of significant fibrosis (p<0.0001 and P<0.0001 respectively) but AST/ALT ratio did not correlate (p 0.195). Conclusion: In patients with chronic CHB, FIB 4 and APRI were more predictive of significant fibrosis than AST/ALT ratio. Non-invasive serum tests can be supportive in diagnosis of significant fibrosis especially in addition to other tests like transient elastography as opposed to more invasive tests such as liver biopsy.990_A Figure 1. Distribution of ethnic groups in study population990_B Figure 2. Receiver Operating Characteristic Curve (ROC) for FIB-4, APRI, AST/ALT ratio