Dynamics of APRI and FIB‑4 in HCV cirrhotic patients who achieved SVR after DAA therapy

Abstract

There are limited data available on the regression of fibrosis in hepatitis C virus (HCV) patients who have achieved sustained virologic response (SVR) after interferon-free treatments. Moreover, a perfect method for assessing liver fibrosis and its dynamics has not been established yet. The main objective of this study was to evaluate the dynamics of aspartate aminotransferase to platelet ratio index (APRI) and Fibrosis-4 (FIB-4) scores in patients with HCV who registered SVR. We performed ROC curve analysis to evaluate the diagnostic performance of APRI and FIB-4 scores in determining the presence of cirrhosis in comparison to FibroTest. In total 251 patients were enrolled: 164 cirrhotic and 83 non-cirrhotic patients, and they were evaluated at baseline, at 6 and at 12 months post-end of treatment (EOT). In the cirrhotic group, at baseline, there was a weak but statistically significant correlation between APRI and FibroTest (τ= 0.173, P=0.001), as well as between FIB-4 and FibroTest (τ= 0.265, P<0.001). At the 6-month follow-up, APRI no longer correlated with FibroTest (τ= 0.144, P= 0.057), while FIB-4 was correlated (τ= 0.256, P= 0.001). The same pattern was shown at 12 months post-EOT. Between baseline and the 6-month evaluation, there was a significant decrease in APRI (P<0.001) and FIB-4 (P<0.001) scores, but for the next follow-up period, there was no reduction. In the non-cirrhotic group, APRI and FIB-4 did not correlate with the FibroTest value at any of the evaluation times. There was a significant difference between baseline and the 6-month visit for APRI (P=0.01) and for FIB-4 (P= 0.014). The areas under the receiver operating characteristics curve (AUROCs) for the presence of cirrhosis compared with FibroTest for APRI and FIB-4 were 0.682 [95% confidence interval (CI), 0.613-0.752] and 0.693 (95% CI 0.625-0.76). Both APRI and FIB-4 prove to be easy, quick and inexpensive tools for screening HCV cirrhosis, with moderate diagnostic accuracy and FIB-4 can be useful for monitoring patients post-EOT.

Real-World Experience of Chronic Hepatitis C-Related Compensated Liver Cirrhosis Treated with Glecaprevir/Pibrentasvir: A Multicenter Retrospective Study

“…There are limited data available on the dynamic changes in liver stiffness among patients with cirrhosis who achieved SVR after interferon-free treatment. However, a significant decrease in the values of APRI and FIB-4 was observed among 164 patients with cirrhosis who achieved SVR with DAA [28]. The German Hepatitis C-Registry [29] found that patients with cirrhosis had a higher magnitude of transient elastography improvement between the baseline and follow-up (25.1 kPa vs. 21.5 kPa; p = 0.002) than those with F2-F3 (8.9 kPa vs. 8.8 kPa; p = 0.060) or F0-F1 (5.3 kPa vs. 5.2 kPa; p = 0.064).…”

The 90‐Day Survival Threshold: A Pivotal Determinant of Long‐Term Prognosis in HBV‐ACLF Patients – Insights from a Prospective Longitudinal Cohort Study

“…Chitinase‐3‐like protein 1 (CHI3L1), is a highly liver‐enriched protein and a driving force of liver fibrosis, serves as a novel noninvasive liver fibrosis biomarker that can accurately stages different stages of liver fibrosis [ 14 ] according to the Metavir Fibrosis Stage [ 11 ] (F0–F4) classification. The aspartate aminotransferase (AST)‐to‐platelet ratio (APRI) and fibrosis‐4 (FIB‐4), two commonly used fibrosis indicators, [ 15 ] along with CHI3L1 [ 16 , 17 ] were used to evaluate liver fibrosis.…”

Severe liver fibrosis in the HCV cure era: Major effects of social vulnerability, diabetes, and unhealthy behaviors

“…The study outcome was the presence of severe liver fibrosis – defined as an FIB-4 >3.25 – as a binary time-varying variable. 14 The choice to use the FIB-4 index was based on its capacity to accurately predict advanced stages of liver fibrosis even after HCV cure, 15 , 16 and its ability to predict complications such as hepatic decompensation and HCC in HCV-infected patients. 17 …”