Soro Dramane*, G Florine, Al-Vera VDM, Lah Bi R
Purpose: To compare the performance of APRI and FIB-4 versus FIBROSCAN in the assessment of fibrosis in chronic viral hepatitis.
Methodology: This was a retrospective descriptive and analytical cross-sectional study, carried out in outpatient consultations for hepatogastroenterology at Cocody University Hospital during the period from January 2016 to June 2020. Patients with viral hepatitis chronic B or C were included. APRI and FIB-4 scores were calculated from the respective formulas. Data were analyzed using SPSS and XLSTAT software. The Chi2 test was used to determine the correlation between the different markers. The sensitivity, specificity, positive predictive value and negative predictive value of APRI and FIB-4 were calculated for the different thresholds and the best Se/Sp compromise evaluated by the ROC curve. The Chi 2 test was used to assess statistically significant associations for a significance level was 0.05.
Results: 694 patients were eligible among which we retained 269 divided into 156 men (57.9%) and 113 women (42.1%). There was a male predominance with a sex ratio of 1.38. The mean age was 39.64 ± 10.8 years. 256 (95.16%) had chronic viral hepatitis B, 13 (4.84%) had chronic viral hepatitis C. Non-significant fibrosis (F0F1) was found in patients under 39 years of age and cirrhosis in patients patients over 48 years of age.
Discussion: According to the APRI and FIB-4 scores, 83.29% and 89.7% of patients had non-significant fibrosis versus 72.9% for FIBROSCAN. The significant fibrosis for FIBROSCAN and APRI was 27.1% versus 16.7%. Severe fibrosis for FIBROSCAN and FIB-4 was 8.4% versus 10.3%. There was a statistically significant association between age, cytolysis, thrombocytopenia and the occurrence of significant fibrosis according to the APRI score and severe fibrosis according to the FIB-4 score. There was a positive correlation between FIBROSCAN and biological fibrosis scores with coefficients of 2.09 for APRI and 0.43 for FIB4 (p-value ˂ 0.005). APRI and FIB-4 scores had high specificities (92.35% and 98.85% respectively) and high negative predictive values (80.8% and 89.12% respectively) for the prediction of significant fibrosis in course of chronic viral hepatitis B and C. The AUROC for detecting significant fibrosis was 0.71 for APRI with a better discriminating threshold of 0.48 (Se: 56.2%, Sp: 85.2%). The AUROC for detecting severe fibrosis was 0.70 for FIB-4 with a best discriminatory cutoff of 3.65 (Se: 70%, Sp: 94.5%).
Conclusion: APRI and FIB-4 scores are powerful markers for detecting fibrosis in chronic viral hepatitis B and C and can be included in recommendations for patient follow up in low income countries
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