Evaluation of APRI and FIB-4 scoring systems for non-invasive assessment of hepatic fibrosis in chronic hepatitis B patients

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• 作者：W. Ray Kim¹ ; ^{wrkim@stanford.edu" class="auth_mail" title="E-mail the corresponding author} ; Thomas Berg² ; Tarik Asselah³ ; Robert Flisiak⁴ ; Scott Fung⁵ ; Stuart C. Gordon⁶ ; Harry L.A. Janssen⁵ ; Pietro Lampertico⁷ ; Daryl Lau⁸ ; Jeffrey D. Bornstein⁹ ; Raul E. Aguilar Schall⁹ ; Phillip Dinh⁹ ; Leland J. Yee⁹ ; Eduardo B. Martins⁹ ; Seng Gee Lim¹⁰ ; Rohit Loomba¹¹ ; Jö ; rg Petersen¹² ; Maria Buti¹³ ; Patrick Marcellin³
• 关键词：CHB ; chronic hepatitis B ; HBV ; hepatitis B virus ; ALT ; alanine aminotransferase ; HCC ; hepatocellular carcinoma ; HCV ; hepatitis C virus ; AST ; aspartate aminotransferase ; APRI ; AST-to-platelet ratio index ; FIB-4 ; fibrosis index based on four factors ; HIV ; human immunodeficiency virus ; ROC ; receiver operating characteristics ; TDF ; tenofovir disoproxil fumarate ; HBeAg ; hepatitis B &lsquo ; e&rsquo ; antigen ; ULN ; upper limit of normal ; PPV ; positive predictive value ; LOX2 ; lysyl oxidase homolog 2 ; HBsA
• 刊名：Journal of Hepatology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：64
• 期：4
• 页码：773-780
• 全文大小：799 K

文摘

While the gold standard in the assessment of liver fibrosis remains liver biopsy, non-invasive methods have been increasingly used for chronic hepatitis B (CHB). This study aimed to evaluate the performance of two commonly used non-invasive scoring systems (aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4)) to predict fibrosis stage in CHB patients.

Methods

Demographic, histologic and clinical laboratory data from two trials investigating tenofovir disoproxil fumarate in CHB were analyzed. Predicted fibrosis stage, based on established scales and cut-off values for APRI and FIB-4 scores, was compared with Ishak scores obtained from liver biopsy at baseline and at 240 week follow-up.

Results

In the 575 patients with a baseline liver biopsy, APRI and FIB-4 scores correlated with Ishak stage (p <0.01); however extensive overlap in the distribution of both scores across Ishak stages prevented accurate determination of fibrosis. The majority (81–89%) of patients with advanced fibrosis or cirrhosis were missed by the scores. Similarly, 71% patients without fibrosis were misclassified as having clinically significant fibrosis. APRI and FIB-4 scores at week 240 tended to be low and underestimate fibrosis stage in the patients with liver biopsies after 240 weeks of therapy. APRI or FIB-4 reduction did not correlate with fibrosis regression after 240 weeks of antiviral therapy.

Conclusions

APRI and FIB-4 scores are not suitable for use in clinical practice in CHB patients for assessment of hepatic fibrosis according to Ishak stage, especially in gauging improvements in liver fibrosis following therapy.