Combination of APRI, FIB-4 and Fibro Touch for predicting early liver fibrosis in chronic hepatitis B patients

Abstract

Abstract: Objective To investigate the predictive value of aminotransferase-to-platelet ratio index (APRI), fibrosis index based on the four factors (FIB-4) and Fibro Touch for early liver fibrosis in chronic hepatitis B (CHB) patients. Methods A total of 402 CHB patients were retrospectively analyzed, including 146 cases in non-liver fibrosis (S0-S1)group, 162 cases in obvious liver fibrosis (S2-S3) group and 94 cases in early cirrhosis (S4) group according to liver pathology. The correlation between APRI, FIB-4 and Fibro Touch combined detection and liver pathology was calculated. The early diagnostic value of noninvasive diagnostic models for liver fibrosis (≥ S2)was analyzed. Meanwhile, the receiver operator characteristic (ROC) curve was performed for the best predictive value, sensitivity and specificity. Results APRI, FIB-4 and Fibro Touch were strongly correlated with liver fibrosis stages (P<0.05), with Spearman correlation coefficients of 0.768, 0.712 and 0.865, respectively. Using multivariate logistic regression analysis, APRI, FIB-4 and Fibro Touch had a certain predictive value for liver fibrosis (P<0.05), with OR values of 1.996, 1.563 and 2.180, respectively. APRI, FIB-4, Fibro Touch were fitted in binary logistic regression with high fitting degree (χ²＝13.689, P＝0.126) for early warning of liver fibrosis : logit(P)＝-0.556+1.119*(APRI)+1.202*(FIB-4)+1.682*(Fibro Touch). In predicting liver fibrosis (≥S2), the combination of APRI, FIB-4 and Fibro Touch had the best predictive value, with the area under ROC curve of 0.928 and the maximum Youden index of 0.819. Meanwhile, Fibro Touch performed better than APRI and FIB-4, which was without any significant difference between APRI and FIB-4. The cutoff value of combination of APRI, FIB-4 and Fibro Touch was 18.14, with sensitivity of 89.6% and specificity of 92.3%.Conclusion Combination of APRI, FIB-4 and Fibro Touch could help predict early liver fibrosis in CHB patients.

Key words: Chronic hepatitis B, Liver fibrosis, Noninvasive diagnosis, Early warning

YU Chong, LI Min, GU Yu-ling, GU Er-li. Combination of APRI, FIB-4 and Fibro Touch for predicting early liver fibrosis in chronic hepatitis B patients[J]. Chinese Hepatolgy, 2018, 23(1): 22-25.

References

[1] Lozano R,Naghavi M,Foreman K,et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380: 2095-2128.
[2] Chang TT,Liaw YF,Wu SS,et al. Long-term entecavir therapy results in the reversal of fibrosis/cirrhosis and continued histological improvement in patients with chronic hepatitis B. Hepatology, 2010, 52:886-893.
[3] Teshale E,Lu M,Rupp LB,et al.APRI and FIB-4 are good predictors of the stage of liver fibrosis in chronic hepatitis B: the Chronic Hepatitis CohortStudy (CHeCS).J Viral Hepat, 2014,21: 917-920.
[4] Wai CT,Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C.Hepatology, 2003, 38: 518-526.
[5] Liang P,Zu J,Yin J,et al.The independent impact of newborn hepatitis B vaccination on reducing HBV prevalence in China,1992-2006:a mathematical model analysis.J Theor Biol, 2015, 386:115-121.
[6] Wu JF,Chang MH.Natural history of chronic hepatitis B virus infection from infancy to adult life-the mechanism of inflammation triggering and long-term impacts.J Biomed Sci, 2015, 22: 92.
[7] Meng F,Zheng Y,Zhang Q,et al.Noninvasive evaluation of liver fibrosis using real-time tissue elastography and transient elastography (FibroScan).J Ultrasound Med, 2015, 34:403-410.
[8] 吴娜,张明媛,吴瑞红.等.FibroTouch与FibroScan对肝纤维化程度诊断价值的比较分析.临床肝胆病杂志, 2014, 30: 624-627.
[9] 亓民.研究分析肝脏硬度测定仪FibroTouch与FibroScan与肝脏病理分期的相关性.中国医药科学, 2016, 21: 218-220.
[10] Li J,Gordon SC,Rupp LB,et al.The validity of serum markers for fibrosis staging in chronic hepatitis B and C. J Viral Hepat, 2014, 21: 930-937.
[11] World Health Organization.Guidelines for the Prevention, Care and Treatment of Persons with Chronic Hepatitis B Infection. Geneva: World Health Organization; 2015.
[12] Kim WR,Berg T,Asselah T,et al.Evaluation of APRI and FIB-4 scoring systems for non-invasive assessment of hepatic fibrosis in chronic hepatitis B patients. J Hepatol, 2016, 64: 773-780.
[13] Chen GF,Ping J,Gu HT.et al.Correlation of liver stiffness measured by FibroTouch and FibroScan with Ishak fibrosis score in patients with chronic hepatitis B. Zhonghua Gan Zang Bing Za Zhi, 2017, 25: 145-150.