Aspartate aminotransferase to platelet ratio index (APRI) and FIB-4 index are noninvasive biomarkers to evaluate hepatic fibrosis. However, their usefulness in chronic hepatitis B (CHB) patients remains unclear.
A total of 631 CHB patients were enrolled and randomly divided into a training set (n=420) and a validation set (n=211). Areas under receiver operating characteristic (AUROC) curves for FIB-4 index and APRI were compared to evaluate their diagnostic values in identifying significant fibrosis and cirrhosis.
The AUROC of FIB-4 index for the diagnosis of significant fibrosis and cirrhosis in the entire cohort was higher than that of APRI (0.769 vs. 0.704, P=0.0003 and 0.869 vs. 0.706, P<0.0001). By using cutoff APRI of 0.38 and 4.04 in the validation set, the diagnostic accuracy for absence of significant fibrosis and presence of cirrhosis was 67.7% and 76.8%. At cutoff FIB-4 index of 0.87 and 3.40 in the validation set, the diagnostic accuracy for absence of significant fibrosis and presence of cirrhosis was 69.2% and 84.4%. Compared with patients with concordance, patients with overestimated score by FIB-4 index had a significantly higher serum alanine aminotransferase (ALT) level (299±245 vs. 168±196 U/L, P=0.001) as well as a higher ratio of hepatitis flare (ALT>400 U/L) (25% vs. 7.9%, P=0.008).
FIB-4 index proves to be more reliable than APRI in predicting significant fibrosis and cirrhosis in CHB patients. By using FIB-4 index, a substantial proportion of patients could be identified correctly as significant fibrosis and cirrhosis without further invasive liver biopsy.
*Department of Gastroenterology, Taipei City Hospital, Ren-Ai branch
†Department of Psychology, National Chengchi University
‡Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine
§Department of Internal Medicine, Division of Gastroenterology and Hepatology
∥Hepatitis Research Center
**Department of Medical Research, National Taiwan University Hospital
#Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei
¶Department of Hepatology, Buddhist Tzu Chi General Hospital, Taipei Branch and School of Medicine, Tzu Chi University, Hualien, Taiwan
Supported by grants from the Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan (to C.-L.L.) and Liver Disease Prevention & Treatment Research Foundation, the Department of Heath, and the National Science Council, Executive Yuan, Taiwan (to J.-H. K.).
C.-L.L.: study concept, conducting, collecting data, statistical analysis, interpreting data, drafting the manuscript, and approved the final manuscript; C.-H. L.: study concept, collecting data, and approved the final manuscript; C.-C. W., C.-C.L., T.-H.S., and C.-J.L.: collecting data and approved the final manuscript; J.-H.K.: study concept, critical revision of the manuscript, and approved the final manuscript. All authors approved the final version of the article.
The authors declare that they have nothing to disclose.
Reprints: Jia-Horng Kao, MD, PhD, Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei 10002, Taiwan (e-mail: email@example.com).
Received April 22, 2014
Accepted September 5, 2014