APRI and FIB-4 indices as diagnostic noninvasive scores for prediction of severe fibrosis in patients with biliary atresia

Abstract

Aim of the study: Biliary atresia (BA) is a blockage in the tubes (ducts) that carry bile from the liver to the gallbladder. The aspartate aminotransferase to platelet ratio (APRI), and Fibrosis-4 (FIB-4) scores are commonly used compound surrogates for advanced fibrosis. However, the use of APRI and FIB-4 entails a risk of overestimating the fibrosis stage due to the impact of necroinflammatory activity on transaminases. So, we determined the optimal cutoff values of the APRI and FIB-4 indices in prediction of fibrosis in BA patients. The aim of the study was to evaluate the validity of the APRI and FIB-4 indices in prediction of fibrosis in patients with BA.

Material and methods: A cross sectional hospital-based study was conducted on 121 children complaining of BA attending the National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt, during the period from January 2022 to February 2023.

Results: The APRI score was significantly higher among neglected BA than BA type II a, BA type III, type II b and type I (p = 0.001). Also FIB-4 was significantly higher among neglected BA than BA type II a, BA type II b, type III and type I (p = 0.001). Receiver operating characteristic (ROC) curve analysis showed that the cutoff point of the APRI score in prediction of fibrosis in patients with BA was 1.29, with sensitivity of 88.6% and specificity of 76.0%, while the cutoff point of FIB-4 in prediction of fibrosis in patients with BA was 9.82 with sensitivity of 89.0% and specificity of 70.0%.

Conclusions: Our study confirms that FIB-4 and APRI scores are both able to predict severe fibrosis. APRI score and FIB-4 are good non-invasive alternatives to liver biopsy in the detection of liver fibrosis and its extent in patients with BA.

Keywords: Fibrosis-4; aspartate transaminase-to-platelet ratio index; biliary atresia; diagnostic tools.

Fig. 1

Flowchart of patients with biliary atresia

Fig. 2

ROC analysis of APRI Index and FIB-4 Index for prediction of fibrosis in patients with biliary atresia

Fig. 3

Liver biopsy. A) A case of biliary atresia (BA) with moderate fibrosis with porto-portal bridging, portal tract showing edema and bile ductular proliferation (H and E 40×; black arrow: intraluminal bile plug). B) A case of BA with moderate fibrosis with porto-portal bridging, portal tract showing edema and bile ductular proliferation (H and E 100×; black arrow: intraluminal bile plug). C) Another case of BA with mild fibrosis limited to portal tract with short septa (Masson Trichrome 40×). D) Another case of BA with moderate fibrosis with porto-portal bridging (Masson Trichrome 100×). E) A case of BA, wedge liver biopsy showing marked fibrosis with incomplete cirrhotic nodule, portal tract showing edema and bile ductular proliferation (H and E 40×), and F) The previous case (Masson Trichrome 40×)