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Prospective Comparison of Noninvasive Fibrosis Assessment to Predict Advanced Fibrosis or Cirrhosis in Asian Patients With Hepatitis C

Joo, Sae Kyung, MD*; Kim, Jung Ho, MD, PhD; Oh, Sohee, PhD; Kim, Byeong Gwan, MD, PhD*; Lee, Kook Lae, MD, PhD*; Kim, Hwi Young, MD, PhD*; Jung, Yong Jin, MD, PhD*; Woo, Hyun Sik, MD§; Moon, Min-Hoan, MD§; Chang, Mee Soo, MD, PhD; Kim, Won, MD, PhD*

Journal of Clinical Gastroenterology: September 2015 - Volume 49 - Issue 8 - p 697–704
doi: 10.1097/MCG.0000000000000215

Goals and Background: The diagnostic role of noninvasive fibrosis assessment, which can obviate liver biopsy in Asian patients with hepatitis C, remains controversial. This study aimed to evaluate the diagnostic accuracy of noninvasive fibrosis assessment to predict advanced fibrosis or cirrhosis in Asian patients with hepatitis C.

Study: A total of 101 antiviral treatment–naive patients with hepatitis C were prospectively enrolled between March 2011 and March 2013. Liver stiffness was measured by acoustic radiation force impulse (ARFI) elastography. At the same time, liver biopsy was performed to obtain histologic data of hepatic fibrosis. Diagnostic measurements of serum fibrosis indices and ARFI imaging were compared with predicted advanced fibrosis or cirrhosis by analyzing the area under the receiver operating characteristic (AUROC) curve.

Results: The median age of the study population was 59 years (range, 25 to 82 y). Aspartate aminotransferase to alanine aminotransferase ratio (AAR), Fib-4, Forns index, aspartate aminotransferase to platelet ratio index (APRI), and Lok index showed significant, positive correlations with METAVIR stages (P<0.001). Fib-4 had the greatest AUROC for advanced fibrosis (≥F3) (0.864; 95% CI, 0.793-0.934), and the Lok index had the highest AUROC for predicting cirrhosis (F4) (0.847; 95% CI, 0.767-0.927). A tendency toward increasing liver stiffness existed in a graded manner across METAVIR stages (P<0.001).

Conclusions: Fib-4 and Lok index were useful noninvasive fibrosis indices for predicting advanced fibrosis and cirrhosis in Asian patients with hepatitis C. In addition, ARFI elastography exhibited acceptable diagnostic performance in the assessment of hepatic fibrosis in patients with hepatitis C.

Departments of *Internal Medicine



§Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea

S.K.J. and J.H.K. contributed equally.

Supported by a clinical research grant-in-aid from the Seoul Metropolitan Government Seoul National University (SMG-SNU) Boramae Medical Center (03-2011-3), and by grant no. 16-2013-66 from the SK Telecom Research Fund.

The authors declare that they have nothing to disclose.

Reprints: Won Kim, MD, PhD, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 156-707 Republic of Korea (e-mail:

Received April 4, 2014

Accepted July 27, 2014

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