title: Validation of FIB-4 and comparison with other simple noninvasive indices for predicting liver fibrosis and cirrhosis in hepatitis B virus-infected patients.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Beom Kyung
authors.initials: BK
authors.lastname: Kim
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Park
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Ahn
authors.forename: Chae Yoon
authors.initials: CY
authors.lastname: Chon
authors.forename: Ja Kyung
authors.initials: JK
authors.lastname: Kim
authors.forename: Yong Han
authors.initials: YH
authors.lastname: Paik
authors.forename: Kwan Sik
authors.initials: KS
authors.lastname: Lee
authors.forename: Young Nyun
authors.initials: YN
authors.lastname: Park
authors.forename: Kwang Hyub
authors.initials: KH
authors.lastname: Han
mesh_terms: 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
chemical_list: D015415:Biomarkers; D012367:RNA, Viral; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase