Abstract
BackgroundLiver fibrosis stage is an important factor in determining prognosis and need for treatment in patients infected with hepatitis B virus (HBV). Liver biopsies are typically used to assess liver fibrosis; however, noninvasive alternatives such as the FIB-4 index have also been developed.AimsTo quantify the accuracy of the FIB-4 index in the diagnosis of HBV related fibrosis and cirrhosis.MethodsA meta-analysis of studies comparing the diagnostic accuracy of the FIB-4 index vs. liver biopsy in HBV-infected patients was performed using studies retrieved from the following databases: PubMed, Ovid, EMBASE, the Cochrane Library, the Chinese National Knowledge Infrastructure and the Chinese Biology Medicine disc. A hierarchical summary receiver operating curves model and bivariate model were used to produce summary receiver operating characteristic curves and pooled estimates of sensitivity and specificity. The heterogeneity was explored with meta-regression analysis. Publication bias was detected using Egger’s test and the trim and fill method.Results12 studies (N = 1,908) and 10 studies (N = 2,105) were included in the meta-analysis for significant fibrosis and cirrhosis, respectively. For significant fibrosis, the area under the hierarchical summary receiver operating curve (AUHSROC) was 0.78 (95% CI = 0.74–0.81). The recommended cutoff value was between 1.45 and 1.62, and the AUHSROC, summary sensitivity and specificity were 0.78 (95% CI = 0.74–0.81), 0.65 (95% CI = 0.56–0.73) and 0.77 (95% CI = 0.7–0.83), respectively. For cirrhosis, the AUHSROC was 0.89 (95% CI = 0.85–0.91). The recommended cutoff value was between 2.9 and 3.6, and the AUHSROC, summary sensitivity and specificity were 0.96 (95% CI = 0.92–1.00), 0.42 (95% CI = 0.36–0.48) and 0.96 (95% CI = 0.95–0.97), respectively. No publication bias was detected.ConclusionsThe FIB-4 index is valuable for detecting significant fibrosis and cirrhosis in HBV-infected patients, but has suboptimal accuracy in excluding fibrosis and cirrhosis.
Highlights
An accurate assessment of liver fibrosis in patients with hepatitis virus B (HBV) infection is essential in determining whether and when to initiate antiviral therapy, and in predicting long-term clinical prognosis [1,2,3]
The FIB-4 index is valuable for detecting significant fibrosis and cirrhosis in hepatitis B virus (HBV)-infected patients, but has suboptimal accuracy in excluding fibrosis and cirrhosis
Its accuracy is affected by sampling error and variability in pathological interpretation [6,7], and the dynamic process of liver fibrosis related to disease progression and regression cannot be quantified
Summary
An accurate assessment of liver fibrosis in patients with hepatitis virus B (HBV) infection is essential in determining whether and when to initiate antiviral therapy, and in predicting long-term clinical prognosis [1,2,3]. With regard to antiviral therapy, it is known that maintenance of viral suppression can reduce liver-related complications in chronic hepatitis B (CHB) patients [1,2,3]. Assessing prognosis in patients with cirrhosis is required to closely follow the potential development of hepatocellular carcinoma and other complications [2,4]. Liver fibrosis stage is an important factor in determining prognosis and need for treatment in patients infected with hepatitis B virus (HBV). Liver biopsies are typically used to assess liver fibrosis; noninvasive alternatives such as the FIB-4 index have been developed
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