APRI and FIB-4 are good predictors of the stage of liver fibrosis in chronic hepatitis B: the Chronic Hepatitis Cohort Study (CHeCS)

J Viral Hepat. 2014 Dec;21(12):917-20. doi: 10.1111/jvh.12279. Epub 2014 Aug 1.


We aim to determine the predictive ability of APRI, FIB-4 and AST/ALT ratio for staging of liver fibrosis and to differentiate significant fibrosis (F2-F4) from none to minimal fibrosis (F0-F1) in chronic hepatitis B (CHB). Liver biopsy results were mapped to an F0-4 equivalent fibrosis stage. Mean APRI and FIB-4 scores were significantly higher for each successive fibrosis level from F1 to F4 (P < 0.05). Based on optimized cut-offs, the AUROCs in distinguishing F2-F4 from F0 to F1 were 0.81 (0.76-0.87) for APRI, 0.81 (0.75-0.86) for FIB-4 and 0.56 (0.49-0.64) for AST/ALT ratio. APRI and FIB-4 distinguished F2-F4 from F0 to F1 with good sensitivity and specificity and can be useful for treatment decisions and monitoring progression of fibrosis.

Keywords: APRI; AST/ALT ratio; FIB-4; chronic hepatitis B; liver fibrosis.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alanine Transaminase / blood*
  • Aspartate Aminotransferases / blood*
  • Biomarkers / blood*
  • Cohort Studies
  • Female
  • Hepatitis B, Chronic / complications*
  • Hepatitis B, Chronic / diagnosis*
  • Hepatitis B, Chronic / pathology
  • Humans
  • Liver Cirrhosis / diagnosis*
  • Liver Cirrhosis / pathology
  • Male
  • Middle Aged
  • Platelet Count
  • Sensitivity and Specificity
  • Severity of Illness Index*


  • Biomarkers
  • Aspartate Aminotransferases
  • Alanine Transaminase