Comparison of Invasive and Non-Invasive Liver Fibrosis Indicators in Chronic Hepatitis C Patients

Abstract

Introduction: Liver biopsy is a standard method used to determine the stage of liver fibrosis. Base formulations have been developed to replace liver biopsy. Materials and Methods: All patients aged 18 years and older, who were diagnosed with chronic hepatitis C and underwent liver biopsy, and who presented to the outpatient clinic of infectious diseases and clinical microbiology at our hospital between January 2011 and January 2017, were included in the study. Liver biopsies of the patients were evaluated according to the modified Knodell (Ishak) fibrosis score. The patients were categorized into two groups based on their fibrosis scores: the low fibrosis group (F0, F1, F2) and the high fibrosis group (F3, F4, F5, F6). The diagnostic performance of non-invasive methods [modified fibrosis-4 index (mFIB-4), fibrosis-4 index (FIB-4), AST/platelet ratio (APRI), AST/ALT ratio (AAR), University of Gothenburg cirrhosis index (GUCI), King’s score, FibroQ test and Lok index] in predicting these two groups were compared retrospectively. Results: A total of 70 patients with chronic hepatitis C, comprising 40 women (57.1%) and 30 men (42.9%), who underwent liver biopsy and sought treatment at the outpatient clinic of infectious diseases and clinical microbiology between January 2011 and January 2017, were included in our study. The mean age of the patients was 50.47 ± 17 years. Based on liver biopsy results, there were 14 patients (20%) with a fibrosis score of 1, 25 patients (35.7%) with a score of 2, 20 patients (28.6%) with a score of 3, seven patients (10%) with a score of 4, and four patients (5.7%) with a score of 5. According to the Ishak score, there were 39 patients (55.7%) with low fibrosis and 31 patients (44.3%) with high fibrosis. The Area under the ROC Curve (AUROC), cut-off values, and p-values were compared to differentiate between patients with low fibrosis and those with high fibrosis. The highest AUROC value was found in the FIB-4 score, followed by the King’s score. Analyzing the noninvasive tests yielded the following results: FIB-4 index: AUROC= 0.749 (95% CI= 0.636-0.863, cutoff= 1.1276, sensitivity= 71%, specificity= 69.2%, p= 0.000); King’s score: AUROC= 0.733 (95% CI= 0.617-0.849, cut-off= 7.9069, sensitivity= 64.5%, specificity= 64.1%, p= 0.001); FibroQ index: AUROC= 0.668 (95% CI= 0.543-0.794, cut-off= 1.5981, sensitivity= 58.1%, specificity= 59%, p= 0.016); mFIB-4 index: AUROC= 0.647 (95% CI= 0.519-0.775, cut-off= 1.7118, sensitivity= 58.1%, specificity= 59%, p= 0.036); GUCI index: AUROC= 0.651 (95% CI= 0.522-0.780, cut-off= 0.4173, sensitivity= 61.3%, specificity= 61.5%, p= 0.031); APRI index: AUROC= 0.644 (95% CI= 0.515-0.774, cut-off= 0.4135, sensitivity= 61.3%, specificity= 59%, p= 0.039). Conclusion: In our study, we found that FIB-4 and King›s score can be used more safely than others in differentiating between low and high fibrosis.

Keywords

• hepatitis c virus
• fibrosis
• biopsy