title: Serum Biomarkers Predictive of Significant Fibrosis and Cirrhosis in Chronic Hepatitis B.
abstract: OBJECTIVE
  Aspartate aminotransferase to platelet ratio index (APRI) and FIB-4 index are noninvasive biomarkers to evaluate hepatic fibrosis. However, their usefulness in chronic hepatitis B (CHB) patients remains unclear.
  
  
  METHODS
  A total of 631 CHB patients were enrolled and randomly divided into a training set (n=420) and a validation set (n=211). Areas under receiver operating characteristic (AUROC) curves for FIB-4 index and APRI were compared to evaluate their diagnostic values in identifying significant fibrosis and cirrhosis.
  
  
  RESULTS
  The AUROC of FIB-4 index for the diagnosis of significant fibrosis and cirrhosis in the entire cohort was higher than that of APRI (0.769 vs. 0.704, P=0.0003 and 0.869 vs. 0.706, P<0.0001). By using cutoff APRI of 0.38 and 4.04 in the validation set, the diagnostic accuracy for absence of significant fibrosis and presence of cirrhosis was 67.7% and 76.8%. At cutoff FIB-4 index of 0.87 and 3.40 in the validation set, the diagnostic accuracy for absence of significant fibrosis and presence of cirrhosis was 69.2% and 84.4%. Compared with patients with concordance, patients with overestimated score by FIB-4 index had a significantly higher serum alanine aminotransferase (ALT) level (299±245 vs. 168±196 U/L, P=0.001) as well as a higher ratio of hepatitis flare (ALT>400 U/L) (25% vs. 7.9%, P=0.008).
  
  
  CONCLUSIONS
  FIB-4 index proves to be more reliable than APRI in predicting significant fibrosis and cirrhosis in CHB patients. By using FIB-4 index, a substantial proportion of patients could be identified correctly as significant fibrosis and cirrhosis without further invasive liver biopsy.
authors.affiliation: *Department of Gastroenterology, Taipei City Hospital, Ren-Ai branch †Department of Psychology, National Chengchi University ‡Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine §Department of Internal Medicine, Division of Gastroenterology and Hepatology ∥Hepatitis Research Center **Department of Medical Research, National Taiwan University Hospital #Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei ¶Department of Hepatology, Buddhist Tzu Chi General Hospital, Taipei Branch and School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors.forename: Chih-Lin
authors.initials: CL
authors.lastname: Lin
authors.forename: Chen-Hua
authors.initials: CH
authors.lastname: Liu
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Cheng-Chao
authors.initials: CC
authors.lastname: Liang
authors.forename: Tung-Hung
authors.initials: TH
authors.lastname: Su
authors.forename: Chun-Jen
authors.initials: CJ
authors.lastname: Liu
authors.forename: Jia-Horng
authors.initials: JH
authors.lastname: Kao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy / Q000379:methods; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase