Comparison of invasive and non-invasive methods for assessment of liver fibrosis in patients with chronic hepatitis B and hepatitis C virus infections

Introduction: Different methods are employed to determine the severity of chronic viral hepatitis and liver fibrosis Objectives: This study was conducted to compare invasive and non-invasive tests for assessment of liver fibrosis in the patients with chronic hepatitis B and C.Patients and Methods: In this study, the results of liver biopsy based on the METAVIR scoring system were compared with biomarkers, including fibrosis-4 (FIB-4) and aspartate aminotransferase-to-platelet ratio index (APRI) for identifying liver fibrosis.Results: Out of 194 patients, 63 and 131 patients had hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, respectively. There was a significant difference between patients with METAVIR stages 0-1 and patients with METAVIR stages 2-3, based on the FIB-4, aspartate aminotransferase (AST) to platelet ratio index (APRI) and the mean prothrombin time (PT), international normalized ratio (INR), platelet (PLT), alanine transaminase (ALT) and AST. A correlation was found between the FIB-4 and APRI indices and the METAVIR score of patients with hepatitis. The FIB-4 index, with a cut-off value <1.1 for detecting liver fibrosis in patients with HBV infection, showed sensitivity of 83.3%, specificity of 64.7%. Further, a positive predictive value (PPV) of 35.7%, and a negative predictive value (NPV) of 94.3% was detected. On the other hand, the APRI index, with a cut-off value <0.73, showed 59% sensitivity, 76.5% specificity, PPV of 33.3% and NPV of 86.7%. The FIB-4 index, with a cut-off value <1.47 for detecting liver fibrosis in patients with HCV infection, showed 73.7% sensitivity, 73.2% specificity, PPV of 31.8%, and NPV of 94.3%. Additionally, the APRI index, with a cut-off value <1.7, showed 42.1% sensitivity, 97.3% specificity, PPV of 72.7% and NPV of 90.8%.Conclusion: According to the results, in patients with chronic hepatitis, the severity of liver fibrosis increased with an increase in the APRI and FIB-4 indices. Therefore, these two indices can replace biopsy under certain circumstances.