Comparison of FIB‐4 and APRI in Chinese HBV‐infected patients with persistently normal ALT and mildly elevated ALT

Abstract

SUMMARY. Significant liver disease has been reported in chronic hepatitis B patients with normal alanine aminotransferase (ALT). Liver biopsy (LB) is the current gold standard for assessing hepatic inflammation and fibrosis in patients with chronic HBV. However, associated risks have led to the development of noninvasive models. Their utility in patients with normal ALT is unknown. FIB-4 and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) were calculated for patients with chronic HBV infection undergoing biopsy. The performance of each model and AUROC for predicting significant fibrosis (Scheuer's score ! S2) were determined for the entire cohort and stratified by elevated ( ! 50 U/L) and normal ALT. Twohundred and thirty-one liver biopsies were included. The number of patient with normal ALT was 140, and 22.1% had significant fibrosis. The AUROC curve for patients with normal ALT was 0.81 for FIB-4 and 0.80 for APRI, compared with 0.71 for FIB-4 and 0.72 for APRI for those with mildly elevated ALT level. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of FIB-4 were 0.63, 0.88, 0.61 and 0.93, for patients with normal ALT; the values for APRI were 0.40, 0.88, 0.33 and 0.93. Both FIB-4 and APRI are useful for identification of those without significant fibrosis. However, because they have poor PPV, LB will continue to be used for assessment of HBV-infected patients with normal ALT and mildly elevated ALT.

The Effectiveness of Noninvasive Biomarkers to Predict Hepatitis B-Related Significant Fibrosis and Cirrhosis: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy

“…The full texts of 110 potentially eligible reports were obtained for further assessment. Of those, 30 papers were included in the review following full-text screening (Table 1); 20 studies were related to the APRI [3], [16], [17], [33]-[49], 13 studies related to the FIB-4 [3], [7], [17], [39]–[46], [48], [50], and 11 studies related to the FibroTest [47]–[49], [51]–[58].…”

“…10 studies used a METAVIR score, 4 studies used an Ishak score, 4 studies used a Scheuer score, 1 study used a Batts and Ludwig score, and 1 study used the Chinese Hospital System. Nineteen of these studies (N = 3,955) included HBV-infected patients without comorbid conditions [3], [16], [17], [33]–[48]. The one remaining study included special populations of patients such as HBV/HDV-coinfected patients (N = 253) [59].…”

“…Some scholars indicated that all of those noninvasive markers were able to predict significant fibrosis or cirrhosis among HBV patients, and could potentially be used to decrease the number of liver biopsies [7]. Others maintained that those markers were not directly applicable to evaluation of HBV-related fibrosis because of the small AUROC curve [17]. Therefore, we decided to conduct this meta-analysis to assess the pooled performance of these biomarkers for prediction of significant fibrosis and cirrhosis among HBV-infected patients.…”

Adipocytokines and liver fibrosis stages in patients with chronic hepatitis B virus infection

“…Both APRI and FIB-4 are useful for identification of those without significant fibrosis [33,34]. An APRI cutoff \0.7 has a 77 % sensitivity and 79 % negative predictive value to exclude significant liver fibrosis [35].…”

Diagnostic accuracy of APRI and FIB-4 for predicting hepatitis B virus-related liver fibrosis accompanied with hepatocellular carcinoma

“…Several researchers have investigated the validity of APRI and FIB-4 for the detection of mild liver fibrosis and cirrhosis in HCV-, HBV-or HIV-infected patients. [14][15][16][17][18][19][20][21][22] The results have been controversial for predicting HBV-related liver fibrosis. Our previous study suggested that the accuracy of these two models for predicting liver fibrosis related by HBV is different from the results of the original articles.…”