Evaluation of aspartate aminotransferase to platelet ratio index and fibrosis 4 score for selecting patients with chronic hepatitis B to perform liver fibrosis assessment by transient elastography in resource-limited areas

Abstract

Background: Liver stiffness measurement operated by transient elastography (TE) becomes a noninvasive method to assess the severity of hepatic fibrosis. However, TE may not be available in resource-limiting areas. Therefore, simple serum biomarker scoring should be evaluated for fibrotic assessment instead of TE.

Objectives: This study aimed to evaluate the diagnostic performance of aspartate. aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) scores compared with TE in chronic hepatitis B (CHB) patients and determine the optimal cut-off values to select the CHB patients who should be referred to higher-level hospital for TE evaluation.

Methods: We conducted a cross-sectional study including 202 patients with chronic hepatitis B who underwent transient elastography. Using TE as a reference standard, the diagnostic performance of APRI and FIB-4 scores were evaluated.

Results: Both APRI and FIB-4 scores demonstrated a significantly moderate correlation with liver stiffness resulting from TE (r = 0.667, P < 0.001; and r = 0.598, P < 0.001, respectively). For evaluation of significant fibrosis, APRI performance was not a significant difference from FIB-4 score as the area under ROC curve (AUROCs) were 0.824 for APRI and 0.780 for FIB-4 score, P = 0.33. APRI < 0.25 and FIB-4 < 0.8 demonstrated the better sensitivity in case of ruling out significant fibrosis. APRI 1.0 and FIB-4 1.7 showed the optimal specificity for ruling in significant fibrosis. Regarding cirrhosis, APRI performance was also not a significant difference from FIB-4 score as the AUROCs were 0.921 for APRI and 0.933 for FIB-4 score, P = 0.78. APRI < 0.5 and FIB-4 < 1.45 had the optimal sensitivity for exclude cirrhosis. APRI 1.5 and FIB-4 3.25 showed the optimal specificity for diagnosis of cirrhosis.

Conclusion: Both APRI and FIB-4 scores were proved to have impressive diagnostic performance in the prediction of significant fibrosis and cirrhosis. We suggest that these new cut-off levels can determine the optimal strategy to select the right patients to receive the appropriate CHB management.