Evaluation of liver fibrosis by non-invasive markers (transient elastography vs. APRI, FIB-4, and FORNS) in chronic hepatitis C virus carriers in a low-income country

Abstract

Background: The interest in evaluating hepatic fibrosis stems from the fact that the risk of developing cirrhosis following hepatitis C virus (HCV) infection is estimated at 10%–20%. The aim of this study was to identify feasible, accessible, and affordable non-invasive methods other than transient elastography (TE) in the evaluation of liver fibrosis in a resource-limited country.
Materials and Methods: This was a cross-sectional analytical study conducted over 24 months in two health facilities in Douala, Cameroon. All chronically infected HCV patients who had undergone a TE were enrolled. In this study, TE was considered the gold standard for evaluating hepatic fibrosis. Other non-invasive markers considered were the aspartate transaminase to platelet ratio (APRI) index, fibrosis-4 (FIB-4), and FORNS scores. The sensitivity (Se), specificity (Sp), positive predictive value, and negative predictive value of each marker to determine significant fibrosis and cirrhosis were calculated for different thresholds, and the best Se/Sp ratio evaluated by the area under the receiving operating characteristic curve.
Results: One hundred eighty-four patients were enrolled. The mean age was 56.2 ± 10.6 years with a female predominance. There was a positive correlation between TE and the FIB-4 score, the APRI score, and the FORNS score. The threshold values to predict significant fibrosis for the FIB-4, APRI, and FORNS score were 2, 0.5, and 7.6, respectively. The threshold values to predict cirrhosis for the FIB-4, APRI, and FORNS scores were 3.2, 1.3, and 9.6, respectively.
Conclusion: The FIB-4 score is the best at predicting significant fibrosis, while the APRI and FIB-4 scores are the best at predicting cirrhosis in hepatitis C patients when compared to TE as the gold standard.