Stepwise application of fibrosis index based on four factors, red cell distribution width–platelet ratio, and aspartate aminotransferase–platelet ratio for compensated hepatitis B fibrosis detection

Chen, Yongpeng; Hu, Xiaomin; Liang, Xieer; Huang, Liwen; Zhu, Yi; Hou, Jinlin

doi:10.1111/jgh.13811

Cited by 14 publications

(11 citation statements)

References 31 publications

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“…A total of 2831 studies were searched by the described search strategies, of which 2627 were excluded following title and abstract screening. Of those, 81 papers were included in the review following full-text screening (Text S5); 47 studies were related to the APRI[24-70], 11 to the ARFI[29,42,69-77], 32 to the FIB-4[24,25,27,30,35,36,39,40,43-46,48-55,57,58,60,62,63,65-69,78-79], 29 to the FibroScan[28,38,42,52,53,58,60,61,71,73,80-98], and 6 to the MRE[99-104].…”

Section: Resultsmentioning

confidence: 99%

Performance of common imaging techniques vs serum biomarkers in assessing fibrosis in patients with chronic hepatitis B: A systematic review and meta-analysis

Xue¹,

Wang²,

Zhang³

et al. 2019

WJCC

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BACKGROUND Noninvasive biomarkers have been developed to predict hepatitis B virus (HBV) related fibrosis owing to the significant limitations of liver biopsy. Both serum biomarkers and imaging techniques have shown promising results and may improve the evaluation of liver fibrosis. However, most of the previous studies focused on the diagnostic effects of various imaging techniques on fibrosis in all chronic liver diseases. AIM To compare the performance of common imaging methods and serum biomarkers for prediction of significant fibrosis caused only by HBV infection. METHODS A systematic review was conducted on the records available in PubMed, EMBASE, and the Cochrane Library electronic databases until December 2018. We systematically assessed the effectiveness of two serum biomarkers and three imagine techniques in predicting significant fibrosis solely caused by HBV infection. The serum biomarkers included aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the 4 factors (FIB-4). The three imaging techniques included acoustic radiation force impulse (ARFI), FibroScan, and magnetic resonance elastography (MRE). Three parameters, the area under the summary receiver operating characteristic curve (AUSROC), the summary diagnostic odds ratio, and the summary sensitivity and specificity, were used to examine the accuracy of all tests for liver fibrosis. RESULTS Out of 2831 articles evaluated for eligibility, 204 satisfied the predetermined inclusion criteria for this current meta-analysis. Eventually, our final data contained 81 studies. The AUSROCs of serum biomarkers of APRI and FIB-4 were both 0.75. For imaging techniques (ARFI, FibroScan, and MRE), the areas were 0.89, 0.83, and 0.97, respectively. The heterogeneities of ARFI and FibroScan were statistically significant ( I 2 > 50%). The publication bias was not observed in any of the serum biomarkers or imaging methods. CONCLUSION These five methods have attained an acceptable level of diagnostic accuracy. Imaging techniques, MRE in particular, demonstrate significant advantages in accurately predicting HBV-related significant fibrosis, while serum biomarkers are admissible methods.

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Section: Resultsmentioning

confidence: 99%

Performance of common imaging techniques vs serum biomarkers in assessing fibrosis in patients with chronic hepatitis B: A systematic review and meta-analysis

Xue¹,

Wang²,

Zhang³

et al. 2019

WJCC

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“…In contrast to our findings, Chen et al found, in a Chinese cohort of chronic hepatitis-B fibrosis patients, FIB-4 and APRI scores to be significantly different between patients with cirrhosis and moderate or severe fibrosis, respectively. 29 The discriminatory potential of a certain test might be influenced by the reference test. We and others 28,29 used histological grading as reference standard, while some studies use TE as reference for fibrosis staging.…”

Section: Discussionmentioning

confidence: 99%

“…The discriminatory potential of a certain test might be influenced by the reference test. We and others used histological grading as reference standard, while some studies use TE as reference for fibrosis staging . Deviations in diagnostic accuracy might also occur due to the type of histologically analyzed specimen, whether a needle biopsy or a surgical specimen is examined.…”

Section: Discussionmentioning

confidence: 99%

Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (LiMAx) test

Heucke

Wuensch

Mohr

et al. 2019

J of Gastro and Hepatol

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Background and Aim Accurate assessment of structural and functional characteristics of the liver could improve the diagnosis and the clinical management of patients with chronic liver diseases. However, the structure–function relationship in the progression of chronic liver disease remains elusive. The aim of this study is the combined measurement of liver function by the 13C‐methacetin Liver MAximum capacity (LiMAx) test and tissue‐structure related stiffness by 2D time‐harmonic elastography for the assessment of liver disease progression. Methods LiMAx test and time‐harmonic elastography were applied, and the serological scores fibrosis 4 index and aspartate aminotransferase to platelet ratio index were calculated in patients with chronic liver diseases (n = 75) and healthy control subjects (n = 22). In 47 patients who underwent surgery, fibrosis was graded by histological examination of the resected liver tissue. Results LiMAx values correlated negatively with liver stiffness (r = −0.747), aminotransferase to platelet ratio index (r = −0.604), and fibrosis 4 (r = −0.573). Median (interquartile range) LiMAx values decreased with fibrosis progression from 395 μg/kg/h (371–460 μg/kg/h) in participants with no fibrosis to 173 μg/kg/h (126–309 μg/kg/h) in patients with severe fibrosis. Median liver stiffness increased progressively with the stage of fibrosis from no fibrosis (1.56 m/s [1.52–1.63 m/s]) to moderate fibrosis (1.60 m/s [1.54–1.67 m/s]) to severe fibrosis (1.85 m/s [1.76–1.92 m/s]). Conclusion Our findings show that structural changes in the liver due to progressing liver diseases and reflected by increased tissue stiffness correlate with a functional decline of the organ as reflected by a decreased metabolic capacity of the liver.

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“…7 Serologic tests and FibroScan have been recommended by the World Health Organization (WHO) as noninvasive tests for CHB patients. 8 However, FibroScan is costly and has been shown to be unfavorable in patients with ascites. 9 Serum markers have been proposed to evaluate liver disease including alanine aminotransferase (ALT), the aspartate aminotransferase (AST)-toplatelet ratio index (APRI), the fibrosis index based on the four factors (FIB-4), the red cell volume distribution width (RDW)-to-platelet ratio (RPR), and the gamma-glutamyl transpeptidase (GGT)-to-platelet ratio (GPR).…”

mentioning

confidence: 99%

Aspartate transaminase to platelet ratio index and gamma‐glutamyl transpeptidase‐to‐platelet ratio outweigh fibrosis index based on four factors and red cell distribution width‐platelet ratio in diagnosing liver fibrosis and inflammation in chronic hepatitis B

Cai

et al. 2017

Clinical Laboratory Analysis

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Stepwise application of fibrosis index based on four factors, red cell distribution width–platelet ratio, and aspartate aminotransferase–platelet ratio for compensated hepatitis B fibrosis detection

Abstract: In source-limited settings without transient elastography, stepwise applying FIB-4, RPR, and APRI could free nearly half of CHB patients from liver biopsies in detecting significant fibrosis and cirrhosis.

Cited by 14 publications

References 31 publications

Performance of common imaging techniques vs serum biomarkers in assessing fibrosis in patients with chronic hepatitis B: A systematic review and meta-analysis

Performance of common imaging techniques vs serum biomarkers in assessing fibrosis in patients with chronic hepatitis B: A systematic review and meta-analysis

Non‐invasive structure–function assessment of the liver by 2D time‐harmonic elastography and the dynamic Liver MAximum capacity (LiMAx) test

Aspartate transaminase to platelet ratio index and gamma‐glutamyl transpeptidase‐to‐platelet ratio outweigh fibrosis index based on four factors and red cell distribution width‐platelet ratio in diagnosing liver fibrosis and inflammation in chronic hepatitis B

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