Abstract: Objective To explore the diagnostic value of transient elastography and serum non-invasive models including APRI, FIB-4, Sheth index, GUCI score, GPR, and King's score in assessing liver fibrosis in patients with chronic drug-induced liver injury. Methods From September 2020 to July 2023, a total of sixty-three patients with chronic drug-induced liver injury who underwent liver biopsy at Beijing You'an Hospital of Capital Medical University were included in the study. LSM values were measured using ultrasonic transient elastography, and APRI, FIB-4, Sheth index, GUCI score, GPR, and King's score were calculated according to the formulas. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic value of each model by calculating the areas under the curves (AUC), sensitivities, specificities, positive predictive values, and negative predictive values. Results Within the 63 patients that were included in this study, 11 patients were pathologically with stage S0-1 of liver fibrosis, 30 with S2, and 22 with S3-4. Except for GPR values [0.98(0.43~1.39) vs. 1.18(0.63~3.06) vs. 1.28(0.85~2.48, P=0.478] that were not significantly different among the three groups of patients (i.e., S0-1 vs. S2 vs. S3-4) , there were differences in LSM values [5.4(5.0~7.4) vs. 14.7(9.55~39.6) vs. 21.3(13.7~33.8), P=0.016], APRI[0.57(0.31~1.64) vs. 1.70(0.67~3.20) vs. 1.35(0.82~2.60), P=0.048], FIB-4[1.19(0.90~3.00) vs. 3.02(1.92~6.46) vs. 4.39(2.61~7.24), P=0.002], Sheth index [0.75(0.52~0.91) vs. 1.04(0.68~2.02) vs. 1.32(0.96~2.15), P=0.009], GUCI score [0.56(0.32~1.76) vs. 1.67(0.70~3.13) vs. 1.39(0.87~3.10), P=0.043], and King's score [10.36(6.46~25.40) vs. 34.12(14.03~67.39) vs. 34.82(13.96~76.65), P=0.022]. The ROC curve of Sheth index had the largest AUC (AUC=0.848, 95%CI=0.723~0.973) and a cutoff value of 1.13 for diagnosing liver fibrosis of S≥2, with a sensitivity of 0.68 and a specificity of 1. Secondly, the AUC of LSM was 0.817 (95%CI=0.631~1.003), the sensitivity was 0.844, and the specificity was 0.857. The AUC of FIB-4, GUCI score, and King's score were all larger than 0.7. The AUC of LSM for diagnosing S≥3 liver fibrosis was 0.728 (95%CI=0.568~0.887), and that of the other indicators was <0.7. Conclusion Compared with transient elastography, APRI, FIB-4, GUCI score, GPR and King's score, the Sheth index has the best diagnostic value for significant liver fibrosis (S≥2).

Key words: Transient elastography, Liver fibrosis, Non-invasive diagnostic model