Kronik hepatit C’li hastaların karaciğer fibrozisini göstermede APRI ve FIB-4 skorlamalarının değeri

Abstract

Purpose: Infection with hepatitis C virus causes chronic liver damage, fibrosis and in later processes, cirrhosis and liver cancer. Currently, the use of biomarkers, instead of invasive procedures, is recommended to identify liver fibrosis. In this study, we aimed to evaluate the sensitivity and specificity of aspartate aminotransferase (AST) to Platelet Ratio Index (APRI) and Fibrosis-4 Index (FIB-4) scoring for detection of "significant fibrosis" in chronic hepatitis C patients.
 Materials and Methods: Liver biopsy results and blood test results of 50 patients, infected with chronic hepatitis C, were analyzed. APRI and FIB-4 scores were calculated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and consistency for APRI and FIB-4 scorings were calculated using a fourfold table. The values of APRI and FIB-4, providing the best specificity and sensitivity in the diagnosis of significant fibrosis, was determined by ROC (receiver operator characteristics curve) analysis.
 Results: The mean fibrosis stage of 30 patients with significant fibrosis was 2.83±0.74 and the mean patient age was 56.8±13. The sensitivity of APRI ≥ 1.5 to detect significant fibrosis was 16%, the specificity was 90%, PPV was 71% and NPV was 41%. A FIB-4 score of ≥3.25 had a sensitivity of 20%, a specificity of 95%, a PPV of 85% and a NPV of 44%. 
 Conclusion: APRI and FIB-4 have high specificity and PPV in demonstrating significant fibrosis, but have low sensitivity and NPV. The sensitivity of FIB-4 was higher compared to the APRI scoring. More research on this subject is needed, as well as revision of fibrosis scores and development of new fibrosis scores.