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Comparison of FIB ‐4 and APRI in Chinese HBV ‐infected patients with persistently normal ALT and mildly elevated ALT
Author(s) -
Wang H.,
Xue L.,
Yan R.,
Zhou Y.,
Wang M. S.,
Cheng M. J.,
Huang H. J.
Publication year - 2013
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.12010
Subject(s) - gastroenterology , medicine , liver biopsy , fibrosis , biopsy , gold standard (test) , receiver operating characteristic , alanine aminotransferase , liver disease , alanine transaminase , liver fibrosis , hepatitis b , area under the curve
Summary Significant liver disease has been reported in chronic hepatitis B patients with normal alanine aminotransferase ( ALT ). Liver biopsy ( LB ) is the current gold standard for assessing hepatic inflammation and fibrosis in patients with chronic HBV . However, associated risks have led to the development of noninvasive models. Their utility in patients with normal ALT is unknown. FIB ‐4 and aspartate aminotransferase ( AST )‐to‐platelet ratio index ( APRI ) were calculated for patients with chronic HBV infection undergoing biopsy. The performance of each model and AUROC for predicting significant fibrosis ( S cheuer's score ≥ S 2) were determined for the entire cohort and stratified by elevated (≥50 U/L) and normal ALT . Two‐hundred and thirty‐one liver biopsies were included. The number of patient with normal ALT was 140, and 22.1% had significant fibrosis. The AUROC curve for patients with normal ALT was 0.81 for FIB ‐4 and 0.80 for APRI , compared with 0.71 for FIB ‐4 and 0.72 for APRI for those with mildly elevated ALT level. The sensitivity, specificity, positive predictive value ( PPV ) and negative predictive value ( NPV ) of FIB ‐4 were 0.63, 0.88, 0.61 and 0.93, for patients with normal ALT ; the values for APRI were 0.40, 0.88, 0.33 and 0.93. Both FIB ‐4 and APRI are useful for identification of those without significant fibrosis. However, because they have poor PPV , LB will continue to be used for assessment of HBV ‐infected patients with normal ALT and mildly elevated ALT .