Validation of FIB-4 and comparison with other simple noninvasive indices for predicting liver fibrosis and cirrhosis in hepatitis B virus-infected patients.
BACKGROUND
To optimize management and predict long-term clinical courses in patients with chronic hepatitis B (CHB), noninvasive tests to determine the degree of hepatic fibrosis have been developed.


OBJECTIVE
This study aimed to validate a simple, noninvasive FIB-4 index, which was first derived from an HCV-HIV-co-infected population, in patients with CHB and to compare it with other noninvasive tests for predicting cirrhosis.


METHODS
From 2006-2008, a total of 668 consecutive CHB patients who underwent liver biopsies were enrolled. The fibrosis stage was assessed according to the Batts and Ludwig system by a single pathologist blinded to patients' data.


RESULTS
For prediction of significant (F > or = 2) and severe (F > or = 3) fibrosis, and cirrhosis (F = 4), the area under the receiver-operating characteristic curves were 0.865, 0.910 and 0.926 respectively. In predicting cirrhosis, it demonstrated diagnostic values comparable to the age-spleen platelet ratio index (0.937, P=0.414) and age-platelet index (0.928, P=0.888), and better outcomes than spleen-platelet ratio index (0.882, P=0.007), aspartate aminotransferase (AST)-platelet ratio index (0.731, P<0.001) and AST-alanine aminotransferase ratio index (0.730, P<0.001). FIB-4 cut-offs of 1.6 and 3.6 provided 93.2% negative predictive value and 90.8% positive predictive value for detection of cirrhosis respectively. Based on these results, liver biopsy could be avoided in 70.5% of the study population. These cut-offs were validated internally using bootstrap resampling methods, showing good agreement.


CONCLUSIONS
FIB-4 is a simple, accurate and inexpensive method of predicting cirrhosis, with outcomes comparable to other noninvasive tests and may reduce the need for liver biopsy in the majority of CHB patients.
Kim
Beom Kyung
BK
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Kim
Do Young
DY
Park
Jun Yong
JY
Ahn
Sang Hoon
SH
Chon
Chae Yoon
CY
Kim
Ja Kyung
JK
Paik
Yong Han
YH
Lee
Kwan Sik
KS
Park
Young Nyun
YN
Han
Kwang Hyub
KH
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D001707:Biopsy, Needle; D015331:Cohort Studies; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000473:pathology* / Q000821:virology; D008297:Male; D010976:Platelet Count; D011237:Predictive Value of Tests; D012367:RNA, Viral / Q000097:blood; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D019562:Viral Load
D015415:Biomarkers; D012367:RNA, Viral; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase