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Liver fibrosis staging with combination of APRI and FIB-4 scoring systems in chronic hepatitis C as an alternative to transient elastography.

Authors
  • Papadopoulos, Nikolaos1
  • Vasileiadi, Sofia2
  • Papavdi, Maria2
  • Sveroni, Eirini1
  • Antonakaki, Pinelopi2
  • Dellaporta, Erminia2
  • Koutli, Evangelia2
  • Michalea, Stavroula2
  • Manolakopoulos, Spilios2, 3
  • Koskinas, John2
  • Deutsch, Melanie2
  • 1 1 Department of Internal Medicine, 417 Army Share Fund Hospital of Athens (Nikolaos Papadopoulos, Eirini Sveroni).
  • 2 Hippokration General Hospital, Athens, Greece, 2 Academic Department of Internal Medicine, National and Kapodistrian University of Athens (Sofia Vasileiadi, Maria Papavdi, Pinelopi Antonakaki, Erminia Dellaporta, Evangelia Koutli, Stavroula Michalea, Spilios Manolakopoulos, John Koskinas, Melanie Deutsch). , (Greece)
  • 3 Laiko General Hospital, Athens, Greece, Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens (Spilios Manolakopoulos), Greece. , (Greece)
Type
Published Article
Journal
Annals of gastroenterology
Publication Date
Jan 01, 2019
Volume
32
Issue
5
Pages
498–503
Identifiers
DOI: 10.20524/aog.2019.0406
PMID: 31474797
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Liver disease severity must be determined before treatment of chronic hepatitis C (CHC). We evaluated the diagnostic performance of the APRI and FIB-4 scores compared to transient elastography liver stiffness (TE-LS) in detecting significant fibrosis (F3) or cirrhosis (F4). We retrospectively enrolled 575 patients with CHC who underwent TE-LS between May 2014 and September 2018: 365 (63.5%) male, mean age 51.54±12.4 years. APRI and FIB-4 scores were compared to TE-LS. One hundred patients (17.5%) had TE-LS values between 9 and 11.9 kPa, and were classified as F3, while 265 (46%) were classified as F4 (TE-LS ≥12 kPa). APRI and FIB-4 scores predicted F4 patients adequately using cutoff values of 0.65 (sensitivity 85.5%, specificity 77%) and 1.63 (sensitivity 91%, specificity 77%), respectively. Cutoff values of 0.64 for APRI and 1.46 for FIB-4 predicted F3/F4 patients (sensitivity 72% and 81.5%; specificity 83% and 79%, respectively). The use of these cutoff values with APRI and FIB-4 in combination adequately predicted patients with significant fibrosis or cirrhosis (positive predictive value 91.5%), while cutoff values of 0.3 and 0.98, respectively, predicted F1/F2 patients with specificity 94.5% and sensitivity 26.5%, suggesting that in 58.5% of patients TE-LS could possibly be avoided. The APRI/FIB-4 combination performed well in predicting significant fibrosis, while FIB-4 performed well in predicting cirrhosis. These noninvasive biochemical markers could be used as screening tools instead of LS measurement, which is not widely available. Further prospective validation studies are required to confirm this finding.

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