title: APRI, the FIB-4 score, and Forn's index have noninvasive diagnostic value for liver fibrosis in patients with chronic hepatitis B.
abstract: OBJECTIVE
  The aim of this study was to evaluate the potential use of serum transforming growth factor-β1 (TGF-β1), tissue inhibitor of metalloproteinase-1 (TIMP-1), fetuin-A, and fibroblast growth factor 21 (FGF21) in the detection of liver fibrosis in patients with chronic hepatitis B (CHB). The value of the noninvasive fibrosis models - that is, the aspartate aminotransferase to platelet ratio index (APRI), the fibrosis index based on the four factors (FIB-4) score, and Forn's index - was also examined.
  
  
  METHODS
  CHB patients who underwent liver biopsy for the evaluation of fibrosis were included in the study. A total of 73 patients were divided into two groups according to their METAVIR scores (F0-1, no/minimal fibrosis; F2-4, significant fibrosis). Serum levels of TGF-β1, TIMP-1, fetuin-A, and FGF21 were measured besides APRI, FIB-4, and Forn's scores. The area under the receiver operating characteristic curve was measured for each parameter, followed by calculation of sensitivity, specificity, and positive and negative predictive values.
  
  
  RESULTS
  APRI, FIB-4, and Forn's index scores were significantly higher in patients with significant fibrosis (P<0.05). There was no difference between no/minimal fibrosis and significant fibrosis groups in terms of serum levels of TGFβ-1, TIMP-1, fetuin-A, and FGF21 (P>0.05). The areas under the receiver operating characteristic curve for TGF-β1, TIMP-1, fetuin-A, FGF21, APRI, FIB-4, and Forn's index were 0.445, 0.483, 0.436, 0.585, 0.662, 0.687, and 0.680, respectively.
  
  
  CONCLUSIONS
  Our results suggest that serum TGF-β1, TIMP-1, fetuin-A, and FGF21 are not useful for the assessment of the extent of liver fibrosis in CHB in this patient group. However, APRI, FIB-4, and Forn's index have a better diagnostic value in patients with significant fibrosis than in those with no/minimal fibrosis.
authors.affiliation: Departments of aClinical Biochemistry bPathology cGastroenterology, Diskapi Yildirim Beyazit Training and Research Hospital dDepartment of Clinical Biochemistry, Numune Training and Research Hospital eDepartment of Clinical Biochemistry, Faculty of Medicine, Fatih University fDepartment of Gastroenterology, Ankara Training and Research Hospital, Ankara, Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Ucar
authors.forename: Sevilay
authors.initials: S
authors.lastname: Sezer
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Ginis
authors.forename: Gulfer
authors.initials: G
authors.lastname: Ozturk
authors.forename: Aynur
authors.initials: A
authors.lastname: Albayrak
authors.forename: Omer
authors.initials: O
authors.lastname: Basar
authors.forename: Fuat
authors.initials: F
authors.lastname: Ekiz
authors.forename: Sahin
authors.initials: S
authors.lastname: Coban
authors.forename: Osman
authors.initials: O
authors.lastname: Yuksel
authors.forename: Ferah
authors.initials: F
authors.lastname: Armutcu
authors.forename: Erdem
authors.initials: E
authors.lastname: Akbal
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D005260:Female; D005346:Fibroblast Growth Factors / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000821:virology; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000097:blood*; D053773:Transforming Growth Factor beta1 / Q000097:blood*; D060749:alpha-2-HS-Glycoprotein / Q000032:analysis*
chemical_list: C556354:AHSG protein, human; D015415:Biomarkers; C508960:TGFB1 protein, human; C560822:TIMP1 protein, human; D019715:Tissue Inhibitor of Metalloproteinase-1; D053773:Transforming Growth Factor beta1; D060749:alpha-2-HS-Glycoprotein; C414620:fibroblast growth factor 21; D005346:Fibroblast Growth Factors; D001219:Aspartate Aminotransferases