title: Evaluation of APRI and FIB-4 scoring systems for non-invasive assessment of hepatic fibrosis in chronic hepatitis B patients.
abstract: OBJECTIVE
  While the gold standard in the assessment of liver fibrosis remains liver biopsy, non-invasive methods have been increasingly used for chronic hepatitis B (CHB). This study aimed to evaluate the performance of two commonly used non-invasive scoring systems (aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4)) to predict fibrosis stage in CHB patients.
  
  
  METHODS
  Demographic, histologic and clinical laboratory data from two trials investigating tenofovir disoproxil fumarate in CHB were analyzed. Predicted fibrosis stage, based on established scales and cut-off values for APRI and FIB-4 scores, was compared with Ishak scores obtained from liver biopsy at baseline and at 240 week follow-up.
  
  
  RESULTS
  In the 575 patients with a baseline liver biopsy, APRI and FIB-4 scores correlated with Ishak stage (p<0.01); however extensive overlap in the distribution of both scores across Ishak stages prevented accurate determination of fibrosis. The majority (81-89%) of patients with advanced fibrosis or cirrhosis were missed by the scores. Similarly, 71% patients without fibrosis were misclassified as having clinically significant fibrosis. APRI and FIB-4 scores at week 240 tended to be low and underestimate fibrosis stage in the patients with liver biopsies after 240 weeks of therapy. APRI or FIB-4 reduction did not correlate with fibrosis regression after 240 weeks of antiviral therapy.
  
  
  CONCLUSIONS
  APRI and FIB-4 scores are not suitable for use in clinical practice in CHB patients for assessment of hepatic fibrosis according to Ishak stage, especially in gauging improvements in liver fibrosis following therapy.
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA. Electronic address: wrkim@stanford.edu.
authors.forename: W Ray
authors.initials: WR
authors.lastname: Kim
authors.affiliation: Universitätsklinikum Leipzig, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Berg
authors.affiliation: Hôpital Beaujon, Paris, France.
authors.forename: Tarik
authors.initials: T
authors.lastname: Asselah
authors.affiliation: Medical University of Bialystok, Bialystok, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Flisiak
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Fung
authors.affiliation: Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Gordon
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Harry L A
authors.initials: HL
authors.lastname: Janssen
authors.affiliation: University of Milan, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Lampertico
authors.affiliation: Harvard University, Boston, MA, USA.
authors.forename: Daryl
authors.initials: D
authors.lastname: Lau
authors.affiliation: Gilead Sciences, Inc., Foster City, CA, USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Bornstein
authors.affiliation: Gilead Sciences, Inc., Foster City, CA, USA.
authors.forename: Raul E Aguilar
authors.initials: RE
authors.lastname: Schall
authors.affiliation: Gilead Sciences, Inc., Foster City, CA, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Dinh
authors.affiliation: Gilead Sciences, Inc., Foster City, CA, USA.
authors.forename: Leland J
authors.initials: LJ
authors.lastname: Yee
authors.affiliation: Gilead Sciences, Inc., Foster City, CA, USA.
authors.forename: Eduardo B
authors.initials: EB
authors.lastname: Martins
authors.affiliation: Yoo Loo Lin School of Medicine, Singapore, Singapore.
authors.forename: Seng Gee
authors.initials: SG
authors.lastname: Lim
authors.affiliation: University of California San Diego, San Diego, CA, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Loomba
authors.affiliation: IFI Institute for Interdisciplinary Medicine, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Petersen
authors.affiliation: Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Buti
authors.affiliation: Hôpital Beaujon, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Marcellin
mesh_terms: D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood*; D001706:Biopsy; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis*; D008297:Male; D010976:Platelet Count; D012720:Severity of Illness Index
chemical_list: D001219:Aspartate Aminotransferases
keywords: APRI; Chronic hepatitis B; FIB-4; Fibrosis