Validation and comparison of simple noninvasive models for the prediction of liver fibrosis in chronic hepatitis C

Ann Hepatol. Nov-Dec 2012;11(6):855-61.

Abstract

Introduction: Although it is standard procedure in the evaluation of liver diseases, biopsy is an invasive method subject to sampling error and intra or inter-observer variability. Thus, surrogate markers of liver fibrosis have been proposed, with variable availability and accuracy.

Aim: Validate and compare the performance of APRI and FIB-4 as predictors of liver fibrosis in HCV patients.

Material and methods: Cross-sectional study including patients with HCV-RNA (+) who underwent liver biopsy. Significant fibrosis was defined as METAVIR stage ≥ 2. The diagnostic performance of the models in predicting significant fibrosis were evaluated and compared by ROC curves.

Results: The study included 119 patients, mean age 43.7 ± 10.6 years and 62% males. Significant fibrosis was identified in 41 patients. The AUROCs observed were: APRI = 0.793 ± 0.047, FIB-4 = 0.811 ± 0.045 and AST/ALT = 0.661 ± 0.055 (P = 0.054 for APRI vs. AST/ALT, and P = 0.014 for FIB-4 vs. AST/ALT). Considering classic cutoffs, the PPV and NPV for APRI and FIB-4 were, respectively, 77% and 92% and 83% and 81%. Thirteen (19%) patients were misdiagnosed by APRI and 16 (18%) by FIB-4. By restricting the indication of liver biopsy to patients with intermediate values, it could have been correctly avoided in 47% and 63% of the patients with APRI and FIB-4, respectively.

Conclusion: The models APRI and FIB-4 were superior to AST/ALT ratio in the diagnosis of significant fibrosis in chronic HCV infection. Even though the overall performance of APRI and FIB-4 was similar, a higher proportion of patients may be correctly classified by FIB-4.

Publication types

  • Comparative Study
  • Validation Study

MeSH terms

  • Adult
  • Age Factors
  • Alanine Transaminase / blood
  • Area Under Curve
  • Aspartate Aminotransferases / blood
  • Biomarkers / blood
  • Biopsy
  • Chi-Square Distribution
  • Cross-Sectional Studies
  • Diagnostic Errors
  • Female
  • Hepacivirus / genetics
  • Hepatitis C, Chronic / complications*
  • Hepatitis C, Chronic / diagnosis
  • Humans
  • Liver / pathology*
  • Liver / virology
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / diagnosis*
  • Liver Cirrhosis / pathology
  • Liver Cirrhosis / virology
  • Male
  • Middle Aged
  • Models, Biological*
  • Platelet Count
  • Predictive Value of Tests
  • RNA, Viral / blood
  • ROC Curve
  • Reproducibility of Results
  • Retrospective Studies
  • Severity of Illness Index
  • Unnecessary Procedures

Substances

  • Biomarkers
  • RNA, Viral
  • Aspartate Aminotransferases
  • Alanine Transaminase