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Abstract

BACKGROUND: Infection with hepatitis B virus (HBV) is a public health problem worldwide; it is the main cause of fibrosis, cirrhosis and hepatocellular carcinoma (HCC).  Early detection of significant fibrosis is essential for reaching antiviral therapy decisions. Considering the limitations of liver biopsy, noninvasive methods to identify significant fibrosis in chronically HBV infected patients are needed in clinical practice. OBJECTIVE: To evaluate the performance of aspartate aminotransferase (AST) to platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) as simple noninvasive markers for staging of liver fibrosis in chronic hepatitis B in comparison with liver biopsy and to compare between the diagnostic performance of APRI and FIB-4 in staging of liver fibrosis. PATIENTS AND METHODS: A combined retrospective (38 case) and prospective (2 cases) study of the records of 40 patients with chronic hepatitis B (CHB) who attended the Gastroenterology and Hepatology Teaching Hospital in Baghdad during the period from (January 2016 - July 2019). All patients had a percutaneous liver biopsy for staging of liver fibrosis. The cases were divided into two groups, non significant fibrosis and significant liver fibrosis, according to histopathology stage of fibrosis. Serum AST, alanine aminotransferase (ALT) levels and platelet counts were obtained from the results of blood samples taken on the same day of liver biopsy. Calculation of APRI and FIB4 indices was done for each pateint of the study . RESULTS:  the diagnostic performance of both indices in significant and non significant fibrosis was determined by Area Under Receiver Operating Curve (AUROC) .The value of AUROC for APRI index  was 0.992, ,P=0.0001,  specificity 100%, sensitivity 95.8% at cut-off value  0.41 and the value of AUROC for FIB4 index  was 0.997, P=0.0001, specificity  100%, sensitivity 95.7% at cut value  0.73. CONCLUSION: Both indices APRI and FIB-4 show good performance with high sensitivity and specificity as simple noninvasive markers for staging of liver fibrosis in CHB.    

DOI

10.52573/ipmj.2021.174627

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