Validation of three non-invasive markers in assessing the severity of liver fibrosis in chronic hepatitis C

J Coll Physicians Surg Pak. 2009 Aug;19(8):478-82.


Objective: To compare various biochemical markers i.e. APRI (AST to platelet ratio index), aspartate aminotransferase (AST) alanine aminotransferase (ALT) ratio, FIB-4 (AST, platelet, AST and age) with biopsy for assessing the severity of hepatic fibrosis in patients with hepatitis C.

Study design: Descriptive study.

Place and duration of study: Medical Department, Liaquat University of Medical and Health Sciences, Jamshoro, from July 2005 to March 2007.

Methodology: Consecutive hepatitis C virus RNA positive and previously untreated patients were studied. Liver biopsy with histological evaluation and AST/ALT ratio, AST to platelet ratio index and FIB-4 were assessed in all patients. Receiver operative curves were developed.

Results: There were 158 patients (109 males, 49 females). On histological grounds non-advanced fibrosis (F0-1) was present in 74 (46.5%) of cases, whereas 84 (53.5%) patients had advanced (F2-4) fibrosis. The area under the receiver operating characteristic curves of APRI < 0.05-1 and FIB-4 < 1.45 were 0.7 and 0.74 respectively, which means that APRI < 1 and FIB-4 < 1.45 will exclude advanced fibrosis in 70% and 74% of patients respectively. An APRI of > 1 and FIB-4 will predict advanced fibrosis in 87% and 98% of patients respectively. AST/ALT ratio was inferior to both of these biomarkers.

Conclusion: Both APRI and FIB-4 not only exclude minimal fibrosis but can predict advanced fibrosis in the majority of the patients. The simultaneous use of several indirect markers of liver fibrosis does not improve their diagnostic accuracy.

Publication types

  • Comparative Study
  • Validation Study

MeSH terms

  • Adult
  • Alanine Transaminase / metabolism*
  • Aspartate Aminotransferases / metabolism*
  • Biomarkers / metabolism
  • Biopsy
  • Confidence Intervals
  • Female
  • Health Status Indicators
  • Hepatitis C, Chronic / complications
  • Hepatitis C, Chronic / pathology*
  • Hepatitis C, Chronic / physiopathology
  • Humans
  • Liver Cirrhosis / etiology
  • Liver Cirrhosis / pathology*
  • Liver Cirrhosis / physiopathology
  • Male
  • Platelet Count*
  • ROC Curve
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Severity of Illness Index


  • Biomarkers
  • Aspartate Aminotransferases
  • Alanine Transaminase