Noninvasive Assessment of Liver Fibrosis By Transient Elastography and FIB4/APRI for Prediction of Treatment Response in Chronic Hepatitis C-An Experience from a Tertiary Care Hospital

Abstract

Background: Liver fibrosis and its sequel cirrhosis represent a major health care burden, and assessment of fibrosis by biopsy is gradually being replaced by noninvasive methods. In clinical practice, the determination of fibrosis stage is important, since patients with advanced fibrosis have faster progression to cirrhosis and antiviral therapy is indicated in these patients.

Aims: To assess the role of transient elastography (TE) and compare it with APRI and FIB4 for predicting liver fibrosis and assessing the effect of host and viral factors on fibrosis and treatment outcome in CHC patients.

Methods: In a retrospective analysis, 330 CHC patients underwent liver stiffness measurement (LSM) by TE and tests needed for calculating APRI and FIB4 scores at baseline. 228 patients received a combination of Pegylated IFN-based antiviral therapy and were analyzed for therapeutic response.

Results: The study included 330 patients (median age 39 years [range 18-67]), predominantly males (n = 227, 68.8%) with baseline LSMs. The median liver stiffness was 7.8 kPa (range 3.2-69.1 kPa). LSMs and its thresholds for severe fibrosis progression (≥9.5 kPa) and cirrhosis (≥12.5 kPa) were significantly higher in patients with age ≥40 years, diabetes mellitus, and patients with significant alcohol intake (P = 0.003 to P < 0.001). By taking TE as a reference, the diagnostic accuracy of FIB4 scores for predicting cirrhosis (AUROC 0.896) was good (+LR 13.4) compared to APRI (AUROC 0.823) with moderate likelihood ratio (+LR 6.9). Among 228 treated patients the SVR rate in genotype 3 was 70% versus 57.8% in genotype 1. Fibrosis score F4 (P = 0.023) and HCV genotype (P = 0.008) were independent predictors of SVR.

Conclusion: The study shows that LSM by TE and fibrosis assessment by FIB4/APRI scores can be used with fair reliability to predict fibrosis and treatment response in patients with CHC infection.

Keywords: ALT, alanine transaminases; APRI, AST to Platelet ratio index; AST, aspartate transaminases; BMI, body mass index; CHB, chronic hepatitis B; CLD, chronic liver disease; DM, diabetes mellitus; ETR, end of treatment response; EVR, early virological response; FIB4, fibrosis-4 score; HCV, hepatitis C; IQR/M, interquartile range/median; LB, liver biopsy; LF, liver fibrosis; LSM, liver stiffness measurement; NPV, negative predictive value; PEG INF, Pegylated Interferon; PPV, positive predictive value; RBV, Ribavarin; RGT, response guided treatment; ROC, receiver operating characteristic; RVR, rapid virological response; SVR, sustained virological response; TE, transient elastography; chronic hepatitis C; kPa, kilopascals; liver biopsy; liver fibrosis; noninvasive markers; transient elastography.

Figure 1

Study enrollment and disposition of HCV infected patients.

Figure 2

(A) AUROC analysis for diagnosis of ≥F2 fibrosis using APRI and FIB4 scores. (B): AUROC analysis for the diagnosis of cirrhosis using APRI and FIB4 scores.