Kronik hepatit C’li hastaların karaciğer fibrozisini göstermede APRI ve FIB-4 skorlamalarının değeri

Year 2023, Volume: 48 Issue: 2, 663 - 668, 02.07.2023

Hatice Burcu Açıkalın Arıkan , Tuna Demirdal , Neriman Bilir

https://doi.org/10.17826/cumj.1273431

Abstract

Amaç: Kronik hepatit C enfeksiyonu kronik karaciğer hasarına, inflamasyona, fibrozise ve ilerleyen süreçlerde siroz ve karaciğer kanserine sebep olmaktadır. Günümüzde, karaciğer fibrozunu tanımlamak için invaziv prosedürler yerine biyobelirteçlerin kullanılması tavsiye edilmektedir. Bu çalışmada, kronik hepatit C hastalarında "belirgin fibrozisi" saptamada aspartat aminotransferaz (AST) Trombosit Oranı İndeksi (APRI) ve Fibrozis-4 İndeksi (FIB-4) skorlamalarının duyarlılık ve özgüllükleri araştırılmıştır.
Gereç ve Yöntem: Kronik hepatit C ile enfekte 50 hastanın karaciğer biyopsi sonuçları ve kan sonuçları analiz edildi. APRI ve FIB-4 puanları hesaplandı. APRI ve FIB-4 skorlamaları için duyarlılık, özgüllük, pozitif prediktif değer (PPD), negatif prediktif değer (NPD) ve tutarlılığı dört gözlü tablo ile hesaplandı. APRI ve FIB-4’ün belirgin fibrozis tanısındaki en iyi spesifite ve sensitiviteye sahip değeri ROC (reciever operator characteristics curve) analizi ile belirlendi.
Bulgular: Belirgin fibrozu olan 30 hastanın ortalama fibrozis evresi 2,83±0,74 ve ortalama hasta yaşı 56,8±13 idi. APRI ≥ 1.5'in belirgin fibrozisi saptama duyarlılığı %16, özgüllüğü %90, PPD %71 ve NPD %41 idi. FIB-4 skorunun ≥3,25 olmasının duyarlılığı %20, özgüllüğü %95, PPD %85 ve NPD %44 olarak bulundu.
Sonuç: Belirgin fibrozisi saptamada APRI ve FIB-4’ün özgüllük ve PPD’si yüksek olmasına rağmen duyarlılığı ve NPD’si düşüktür. FIB-4 skorunun duyarlılığı APRI’den daha yüksektir. Bu konuda daha fazla araştırmaya, fibrozis skorlarının revize edilmesine ve yeni fibrozis skorları geliştirilmesine ihtiyaç vardır.

Keywords

APRI, AST, Kronik hepatit C, FIB-4, Belirgin fibrozis

The value of APRI and FIB-4 scores in detection of liver fibrosis of patients with chronic hepatitis C

Abstract

Purpose: Infection with hepatitis C virus causes chronic liver damage, fibrosis and in later processes, cirrhosis and liver cancer. Currently, the use of biomarkers, instead of invasive procedures, is recommended to identify liver fibrosis. In this study, we aimed to evaluate the sensitivity and specificity of aspartate aminotransferase (AST) to Platelet Ratio Index (APRI) and Fibrosis-4 Index (FIB-4) scoring for detection of "significant fibrosis" in chronic hepatitis C patients.
Materials and Methods: Liver biopsy results and blood test results of 50 patients, infected with chronic hepatitis C, were analyzed. APRI and FIB-4 scores were calculated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and consistency for APRI and FIB-4 scorings were calculated using a fourfold table. The values of APRI and FIB-4, providing the best specificity and sensitivity in the diagnosis of significant fibrosis, was determined by ROC (receiver operator characteristics curve) analysis.
Results: The mean fibrosis stage of 30 patients with significant fibrosis was 2.83±0.74 and the mean patient age was 56.8±13. The sensitivity of APRI ≥ 1.5 to detect significant fibrosis was 16%, the specificity was 90%, PPV was 71% and NPV was 41%. A FIB-4 score of ≥3.25 had a sensitivity of 20%, a specificity of 95%, a PPV of 85% and a NPV of 44%.
Conclusion: APRI and FIB-4 have high specificity and PPV in demonstrating significant fibrosis, but have low sensitivity and NPV. The sensitivity of FIB-4 was higher compared to the APRI scoring. More research on this subject is needed, as well as revision of fibrosis scores and development of new fibrosis scores.

Keywords

APRI, AST, Chronic hepatitis C, FIB-4, Significant fibrosis

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