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. 2024 Nov 29;6(1):16-21.
doi: 10.14744/hf.2024.2024.0024. eCollection 2025.

Performance of non-invasive fibrosis markers in biopsy-proven liver disorders

Nilay Danis  1 , Fulya Gunsar  2 , Funda Yilmaz  3 , Deniz Nart  3 , Ilker Turan  2 , Zeki Karasu  2 , Galip Ersoz  2 , Ulus Salih Akarca  2 , Omer Ozutemiz  2
Affiliations

Performance of non-invasive fibrosis markers in biopsy-proven liver disorders

Nilay Danis et al. Hepatol Forum. .

Abstract

Background and aim: The primary aim of this study was to investigate the concordance of Transient Elastography FibroScan® (FS) measurements, Fibrosis-4 (FIB-4), and the Aspartate Aminotransferase to Platelet Ratio Index (APRI) scores with each other and with liver biopsies in predicting histological fibrosis.

Materials and methods: In this single-center, cross-sectional, retrospective collected data cohort study spanning seven consecutive years, simultaneous FS measurements, FIB-4, and APRI scores of 778 patients with different diagnoses who had undergone liver biopsy were evaluated.

Results: A total of 417 (53.6%) of the patients were female. The median age was 51 years. The diagnoses were HBV (n=228), metabolic dysfunction-associated steatotic liver disease (MASLD) (n=185), HCV (n=58), cryptogenic (n=53), primary biliary cholangitis (n=40), autoimmune hepatitis (AIH) (n=28), overlap syndrome (OS) (n=23), multiple diagnoses (n=42), and other diagnoses (n=83). All three methods showed a strong correlation with histological fibrosis, and FS demonstrated a statistically significantly superior relationship compared to FIB-4 and APRI. In AIH and OS, FIB-4 and APRI scores do not show a consistent increase with histological stage; however, FS does. In MASLD, all three methods correlate with histologic stage, but FS measurements appear significantly superior.

Conclusion: Although FIB-4, APRI, and FS correlate well with histological fibrosis, especially in MASLD, evaluation with FS, if available, should be preferred. In the evaluation of fibrosis in AIH and OS, laboratory-based indicators should be avoided.

Keywords: FIB-4; liver biopsy; transient elastography.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Correlation of non-invasive fibrosis markers with the liver biopsy fibrosis stage.
Figure 2
Figure 2
Median (95% CI) values of non-invasive fibrosis indicators at different stages of liver biopsy.
Figure 3
Figure 3
Relationship between stage in liver biopsy and non-invasive indicators in patients with autoimmune hepatitis.
Figure 4
Figure 4
Relationship between stage in liver biopsy and non-invasive indicators in patients with overlap syndrome.
Figure 5
Figure 5
Relationship between stage and non-invasive indicators in liver biopsy in MASLD patients.
See this image and copyright information in PMC

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