Diagnostic accuracy of FIB-4, APRI and AST/ALT ratio for prediction of fibrosis in chronic hepatitis B and C patients

Background and Objectives: Accurate assessment of liver fibrosis is essential for successful disease management for people with chronic hepatitis B (CHB) and chronic hepatitis C (CHC). Although liver biopsy remains gold standard for diagnosis of liver fibrosis, it has some limitations. To overcome these limitations multiple noninvasive modalities have been introduced. The main aim of our study was to validate the various fibrosis scoring systems with liver biopsy and give recommendations to replace it with these scoring systems if feasible in hepatitis B and C.Methods: We included 62 patients, 32 (51.60%) had hepatitis B, and 30 (48.40%) had hepatitis C infection. These patients were enrolled from Out Patient Department and In Patient Department of Sri Maharaja Hari Singh Hospital, Srinagar. We examined the validity of commonly used liver fibrosis scoring systems: FIB-4 (Fibrosis-4 Index), APRI (Aspartate aminotransferase to Platelet Ratio) and AST (Aspartate Aminotransferase)/ ALT(Alanine Aminotransferase) ratio. Liver biopsy was histologically graded using Knodell, Ishak and Metavir grading systems. On basis of histopathological examination, the patients were divided into those with non-significant fibrosis (F0-F2) and significant fibrosis (F3-F4); and those without cirrhosis (F0-F3) and with cirrhosis (F4).Results: In case of CHB patients, all 32(100%) belonged to non-significant fibrosis group (F0-F2) and none had cirrhosis. In case of CHC, 12(40%) patients had insignificant fibrosis while as 18(60%) had fibrosis to cirrhosis. The sensitivity and specificity of FIB-4 in detecting significant fibrosis was 91.7% and 88.9% respectively. For cirrhosis, these parameters were 100% and 81.8% respectively. The sensitivity and specificity of APRI in detecting significant fibrosis was 75% and 91.4% respectively and for cirrhosis, 87.5% and 82.4% respectively. The sensitivity and specificity of AST/ALT ratio in detecting significant fibrosis was 50% and 83.9% while for cirrhosis, 57.5% and 80.9% respectively.Conclusion: Our study suggests that FIB-4 and APRI are excellent surrogate markers for liver fibrosis, ASL/ALT is not a very sensitive marker. Among all, FIB-4 fared the best.Keywords: Liver fibrosis, Non-invasive methods, Liver biopsy, Hepatitis B, Hepatitis C