Re-determining the cut-off points of FIB-4 for patients monoinfected with chronic hepatitis B virus infection

Abstract

Objective:This study aimed to determine significant liver fibrosis and cirrhosis with different FIB-4 cut-off points, and the need for liver biopsy (LB) by optimizing the initially established cut-off points of 1.45 and 3.25.Materials and methods:The study included 201 patients monoinfected with chronic HBV. METAVIR classification was used to determine the stage of fibrosis. ROC analysis and the Youden index were performed to define the optimum cut-off points.Results:A FIB-4 cut-off point of 1.45 and 1.62 generated Youden indexes of 0.51 and 0.55, the accuracy of 78.6% and 81.1% for significant liver fibrosis, respectively. The FIB-4 cut-off was set at 2.40 and 3.25 Youden indexes were 0.46 and 0.16, accuracies were 79.6% and 69.7% for significant liver fibrosis, respectively. A cut-off point of 1.45 and 1.62 for FIB-4 generated Youden indexes of 0.62 and 0.66, the accuracies of 81.6% and 84.1% for cirrhosis, while the FIB-4 cut-off point of 2.40 and 3.25 generated Youden indexes of 0.59 and 0.22, with the accuracies of 90% and 84.1% for cirrhosis, respectively.Conclusions:The FIB-4 cut-off points of 1.62 and 2.40 have higher accuracy and may decrease the need for LB 12% more than the initially established ones in HBV monoinfected patients.

Letter: changes in FIB‐4 cut‐off points for viral hepatitis

“…Dr Kayadibi shows that the specificity and sensitivity of the lower FIB-4 cut-off can be improved with adjusted cut-offs in HBV mono-infection. 2 This is likely true for HDV infected individuals as well, though our colleagues must appreciate the higher necroinflammatory scores on liver biopsies and corresponding higher transaminases in this cohort as described in our paper. Further work should be done to establish noninvasive markers of fibrosis to identify HDV infected patients with and without advanced fibrosis.…”

“…Koh et al 1 used just a single cut-off point, while Kayadibi et al 2 used both lower and upper cut-off points. In clinical practice, the use of a single cut-off point may not result in a sufficiently high sensitivity and specificity to rule out (or rule in) an outcome of interest, whereas the use of low and high cut-off points results in high sensitivity and specificity.…”