Diagnostic accuracy of APRI and FIB-4 for predicting hepatitis B virus-related liver fibrosis accompanied with hepatocellular carcinoma.
BACKGROUND
Aspartate aminotransferase to platelet ratio index (APRI) and the fibrosis index based on four factors (FIB-4) are the two most focused non-invasive models to assess liver fibrosis.


OBJECTIVE
We aimed to examine the validity of these two models for predicting hepatitis B virus (HBV)-related liver fibrosis accompanied with hepatocellular carcinoma (HCC).


METHODS
We enrolled HBV-infected patients with liver cancer who had received hepatectomy. The accuracy of APRI and FIB-4 for diagnosing liver fibrosis was assessed based on their sensitivity, specificity, diagnostic efficiency, positive predictive value (PPV), negative predictive value (NPV), kappa (κ) value and area under the receiver-operating characteristic curve (AUC).


RESULTS
Finally 2176 patients were included, with 1682 retrospective subjects and 494 prospective subjects. APRI (rs=0.310) and FIB-4 (rs=0.278) were positively correlated with liver fibrosis. And χ(2) analysis demonstrated that APRI and FIB-4 values correlated with different levels of liver fibrosis with all P values less than 0.01. The AUC values for APRI and FIB-4 were 0.685 and 0.626 (P=0.73) for predicting significant fibrosis, 0.681 and 0.648 (P=0.81) for differentiation of advanced fibrosis and 0.676 and 0.652 (P=0.77) for diagnosing cirrhosis.


CONCLUSIONS
APRI and FIB-4 correlate with liver fibrosis. However these two models have low accuracy for predicting HBV-related liver fibrosis in HCC patients.
Department of Hepato-pancreato-biliary Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China; Department of Liver Surgery and State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China.
Guangqin
G
Xiao
Department of Hepato-pancreato-biliary Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Feng
F
Zhu
Department of Hepato-pancreato-biliary Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Min
M
Wang
Department of Hepato-pancreato-biliary Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Hang
H
Zhang
Department of Oncology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Dawei
D
Ye
Department of Liver Surgery and State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China.
Jiayin
J
Yang
Department of Liver Surgery and State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China.
Li
L
Jiang
Department of Liver Surgery and State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China.
Chang
C
Liu
Department of Liver Surgery and State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China. Electronic address: yanlunan1268@163.com.
Lunan
L
Yan
Department of Hepato-pancreato-biliary Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China. Electronic address: qinrenyi1515@163.com.
Renyi
R
Qin
D000328:Adult; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000821:virology; D002681:China; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy; D006515:Hepatitis B virus; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000821:virology; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D001219:Aspartate Aminotransferases
Aspartate aminotransferase to platelet ratio index; Hepatitis B virus; Liver fibrosis; The fibrosis index based on four factors