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

• Published in: Annals of hepatology Vol. 11; no. 6; pp. 855 - 861
• Main Authors: Amorim, Thabata Glenda Fenili, Staub, Guilherme Jönck, Lazzarotto, César, Silva, André Pacheco, Manes, Joice, Ferronato, Maria da Graça, Shiozawa, Maria Beatriz Cacese, Narciso-Schiavon, Janaína Luz, Dantas-Correa, Esther Buzaglo, Schiavon, Leonardo de Lucca
• Format: Journal Article
• Language: English
• Published: Mexico Elsevier 01-11-2012
• Subjects: Adult; Age Factors; Alanine Transaminase - blood; Area Under Curve; Aspartate Aminotransferases - blood; Biomarkers; Biomarkers - blood; Biopsy; Chi-Square Distribution; Cross-Sectional Studies; Diagnosis; Diagnostic Errors; Female; Hepacivirus - genetics; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - diagnosis; Humans; Liver - pathology; Liver - virology; Liver cirrhosis; Liver Cirrhosis - blood; Liver Cirrhosis - diagnosis; Liver Cirrhosis - pathology; Liver Cirrhosis - virology; Male; Middle Aged; Models, Biological; Platelet Count; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; RNA, Viral - blood; ROC Curve; Severity of Illness Index; Unnecessary Procedures
• ISSN: 1665-2681
• DOI: 10.1016/s1665-2681(19)31410-3

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