Comparison of diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis‐4 index for detecting liver fibrosis in adult patients with chronic hepatitis B virus infection: A systemic review and meta‐analysis

Abstract

The aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the four factors (Fibrosis 4 index; FIB-4) are the two most widely studied noninvasive tools for assessing liver fibrosis. Our aims were to systematically review the performance of APRI and FIB-4 in hepatitis B virus (HBV) infection in adult patients and compare their advantages and disadvantages. We examined the diagnostic accuracy of APRI and FIB-4 for significant fibrosis, advanced fibrosis, and cirrhosis based on their sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUROC). Heterogeneity was explored using metaregression. Our systemic review and meta-analysis included 16 articles of APRI only, 21 articles of APRI and FIB-4 and two articles of FIB-4 for detecting different levels of liver fibrosis. With an APRI threshold of 0.5, 1.0, and 1.5, the sensitivity and specificity values were 70.0% and 60.0%, 50.0% and 83.0%, and 36.9% and 92.5% for significant fibrosis, advanced fibrosis, and cirrhosis, respectively. With an FIB-4 threshold of 1.45 and 3.25, the sensitivity and specificity values were 65.4% and 73.6% and 16.2% and 95.2% for significant fibrosis. The summary AUROC values using APRI and FIB-4 for the diagnosis of significant fibrosis, advanced fibrosis, and cirrhosis were 0.7407 (95% confidence interval [CI]: 0.7033-0.7781) and 0.7844 (95% CI: 0.7450-0.8238; (Z 5 1.59, P 5 0.06), 0.7347 (95% CI: 0.6790-0.7904) and 0.8165 (95% CI: 0.7707-0.8623; Z 5 2.01, P 5 0.02), and 0.7268 (95% CI: 0.6578-0.7958) and 0.8448 (95% CI: 0.7742-0.9154; (Z 5 2.34, P 5 0.01), respectively. Conclusions: Our meta-analysis suggests that APRI and FIB-4 can identify hepatitis B-related fibrosis with a moderate sensitivity and accuracy. (HEPATOLOGY 2015;61:292-302)

Clinical implication of the preoperative GSA index in 99mTc-GSA scintigraphy in hepatitis C virus-related hepatocellular carcinoma

“…In addition, a recent metaanalysis regarding diagnostic accuracy of FIB-4 and APRI in patients with chronic hepatitis B infection showed that the mean AUROCs of FIB-4 and APRI for predicting cirrhosis were 0.78 and 0.72, while our data of FIB-4 and APRI were 0.771 and 0.761. Although the causes of liver diseases were different between their data and ours, our results were similar to their reports (29).…”

Liver Fibrosis: Causes and Methods of Assessment, A Review

“…The diagnostic accuracy of APRI and FIB-4 for significant fibrosis, advanced fibrosis, and cirrhosis was investigated in a systematic review [47]. They included 16 articles of APRI only, 21 articles of APRI and FIB-4 and two articles of FIB-4 for detecting different levels of liver fibrosis.…”

Red Cell Volume Distribution Width to Platelet Ratio is an Important Predictor of Liver Fibrosis and Cirrhosis in Chronic Hepatitis B

“…PLT is used in various predictive models of liver fibrosis and cirrhosis. In a meta-analysis, it has been shown that aspartate aminotransferase (AST)-PLT ratio index (APRI) and fibrosis-4 (FIB-4) index can identify liver fibrosis in CHB with a moderate sensitivity and accuracy (20). Chen et al (7) are the first investigators reporting an association between RDW and liver fibrosis and have reported that in the study, the most robust predictors in CHB patients namely RDW and PLT when used to get RPR have led to more accurate prediction of the risk of significant fibrosis (63.1%) and cirrhosis (73.7%) compared to AST-alanine aminotransferase (ALT) ratio (AAR), FIB-4 and APRI.…”