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

Yıl 2023, Cilt: 48 Sayı: 2, 663 - 668, 02.07.2023

Hatice Burcu Açıkalın Arıkan , Tuna Demirdal , Neriman Bilir

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

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• World Health Organization. Hepatitis C. 2022 Jun 23 (accessed Feb 2023). Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c.
• Smith A, Baumgartner K, Bositis C. Cirrhosis: diagnosis and management. Am Fam Physician. 2019;100:759-70.
• Hoefs JC, Shiffman ML, Goodman ZD, Kleiner DE, Dienstag JL, Stoddard AM; HALT-C Trial Group. Rate of progression of hepatic fibrosis in patients with chronic hepatitis C: results from the HALT-C Trial. Gastroenterology. 2011;141:900-8.e1-2.
• Patel K, Sebastiani G. Limitations of non-invasive tests for assessment of liver fibrosis. JHEP Rep. 2020;2:100067.
• Bedossa P, Dargère D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology. 2003;38:1449-57.
• World Health Organization. Guidelines for the Screening, Care and Treatment of Persons with Chronic Hepatitis C Infection: Updated Version. Geneva, WHO, 2016.
• Ghany MG, Morgan TR; AASLD-IDSA Hepatitis C Guidance Panel. Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases-Infectious Diseases Society of America Recommendations for testing, managing, and treating hepatitis c virus infection. Hepatology. 2020;71:686-721.
• European Association for the Study of the Liver. Electronic address: [e-mail]; Clinical Practice Guidelines Panel: Chair: EASL Governing Board representative; Panel members: EASL recommendations on treatment of hepatitis C: Final update of the series☆. J Hepatol. 2020;73:1170-1218.
• Itakura J, Kurosaki M, Setoyama H, Simakami T, Oza N, Korenaga M et al. Applicability of APRI and FIB-4 as a transition indicator of liver fibrosis in patients with chronic viral hepatitis. J Gastroenterol. 2021;56:470-78.
• Knodell RG, Ishak KG, Black WC, Chen TS, Craig R, Kaplowitz N, Kiernan TW, Wollman J. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology. 1981;1:431-5.
• Söğütçü N, Kaya Ş. Evaluation of liver biopsy results in chronic hepatitis B patients. Van Medical Journal. 2020;27:403-6.
• Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1995;22:696-9.
• Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518-26.
• Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J et al; APRICOT Clinical Investigators. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43:1317-25.
• Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology. 2007;46:32-6.
• Kaya O, Akçam FZ, Sönmez Y, Tiğli A, Çiriş M. Evaluation of non-invasive methods for prediction of fibrosis in chronic hepatitis b and c infections. Viral Hepatit Dergisi. 2009;14:91-7.
• Usluer G, Erben N, Aykin N, Dagli O, Aydogdu O, Barut S et al. Comparison of non-invasive fibrosis markers and classical liver biopsy in chronic hepatitis C. Eur J Clin Microbiol Infect Dis. 2012;31:1873-8.
• Cheng CH, Chu CY, Chen HL, Lin IT, Wu CH, Lee YK et al. Subgroup analysis of the predictive ability of aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) for assessing hepatic fibrosis among patients with chronic hepatitis C. J Microbiol Immunol Infect. 2020;53:542-9.
• Cheng PN, Chiu HC, Chiu YC, Chen SC, Chen Y. Comparison of FIB-4 and transient elastography in evaluating liver fibrosis of chronic hepatitis C subjects in community. PLoS One. 2018;13:e0206947.