Acoustic Radiation Force Impulse Elastography with APRI and FIB-4 to Identify Significant Liver Fibrosis in Chronic Hepatitis B Patients

Cheng-Hao Tseng; Chi-Yang Chang; Lein-Ray Mo; Jaw-Town Lin; Chi-Ming Tai; Daw-Shyong Perng; Chih-Wen Lin; Yao-Chun Hsu

2018, Number 5

Ann Hepatol 2018; 17 (5)

Acoustic Radiation Force Impulse Elastography with APRI and FIB-4 to Identify Significant Liver Fibrosis in Chronic Hepatitis B Patients

Tseng, Cheng-Hao; Chang, Chi-Yang; Mo, Lein-Ray; Lin, Jaw-Town; Tai, Chi-Ming; Perng, Daw-Shyong; Lin, Chih-Wen; Hsu, Yao-Chun

Full text

How to cite this article

Language: English
References: 23
Page: 789-794
PDF size: 184.49 Kb.

ABSTRACT

Introduction and aim. In chronic hepatitis B (CHB) patients with equivocal indication for antiviral therapy, therapeutic decision currently depends on histopathology of the liver. We aimed to evaluate if acoustic radiation force impulse (ARFI) in conjunction with aspartate transaminase to platelet ratio index (APRI) and fibrosis-4 (FIB-4) score could replace liver biopsy to indicate treatment for CHB. Material and methods. We prospectively enrolled 101 clinically non-cirrhotic patients whose serum alanine aminotransferase was mildly elevated (1-2 folds above the upper normal limit) despite a high viral load (HBV DNA › 2,000 IU/mL). All participants underwent liver biopsy, and measurement of ARFI, APRI and FIB-4. The ability of the markers to distinguish fibrosis ≥ METAVIR F2 was evaluated. Results. According to histopathology, liver fibrosis was METAVIR F0 in 2 (2.0%), F1 in 43 (42.6%), F2 in 34 (33.7%), F3 in 16 (15.8%), and F4 in 6 (5.9%) patients, and was correlated with ARFI (p = 0.0001), APRI (p = 0.012), and FIB-4 (p = 0.004). The six patients with cirrhosis were included for analysis, and received antiviral therapy. The C statistics of ARFI, APRI, and FIB-4 for fibrosis ≥ F2 were 0.70 (95% confidence interval [CI], 0.59-0.80), 0.62 (95% CI, 0.51-0.73), and 0.64 (0.53- 0.75), respectively. The cut-off values for 95% sensitivity and 95% specificity to identify significant fibrosis were 0.97 m/sec and 1.36 m/sec for ARFI, 0.36 and 1.0 for APRI, 0.63 and 2.22 for FIB-4, respectively. Using a combination of these 3 indices, 44 patients (43.6%) could be spared a liver biopsy procedure. Conclusions. A combination of ARFI, APRI, and FIB-4 may spare some CHB patients with equivocal indication for antiviral treatment a liver biopsy.

REFERENCES

Liaw YF, Kao JH, Piratvisuth T, Chan HL, Chien RN, Liu CJ, Gane E, et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2012 update. Hepatol Int 2012: 6: 531-61.
Sokal EM, Paganelli M, Wirth S, Socha P, Vajro P, Lacaille F, Kelly D, et al. Management of chronic hepatitis B in childhood: ESPGHAN clinical practice guidelines: consensus of an expert panel on behalf of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. J Hepatol 2013: 59: 814-29.
Terrault NA, Bzowej NH, Chang KM, Hwang JP, Jonas MM, Murad MH, American Association for the Study of Liver D. AASLD guidelines for treatment of chronic hepatitis B. Hepatology 2016: 63: 261-83.
Castera L. Noninvasive methods to assess liver disease in patients with hepatitis B or C. Gastroenterology 2012: 142: 1293-302 e4.
Castera L. Hepatitis B: are non-invasive markers of liver fibrosis reliable? Liver Int 2014: 34(Suppl. 1): 91-6.
Takahashi H, Ono N, Eguchi Y, Eguchi T, Kitajima Y, Kawaguchi Y, Nakashita S, et al. Evaluation of acoustic radiation force impulse elastography for fibrosis staging of chronic liver disease: a pilot study. Liver Int 2010: 30: 538-45.
Jin W, Lin Z, Xin Y, Jiang X, Dong Q, Xuan S. Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis B-related fibrosis: a leading meta-analysis. BMC Gastroenterol 2012: 12: 14.
Lin ZH, Xin YN, Dong QJ, Wang Q, Jiang XJ, Zhan SH, Sun Y, et al. Performance of the aspartate aminotransferase-toplatelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis. Hepatology 2011: 53: 726-36.
Houot M, Ngo Y, Munteanu M, Marque S, Poynard T. Systematic review with meta-analysis: direct comparisons of biomarkers for the diagnosis of fibrosis in chronic hepatitis C and B. Aliment Pharmacol Ther 2016: 43: 16-29.
Teshale E, Lu M, Rupp LB, Holmberg SD, Moorman AC, Spradling P, Vijayadeva V, et al. APRI and FIB-4 are good predictors of the stage of liver fibrosis in chronic hepatitis B: the Chronic Hepatitis Cohort Study (CHeCS). J Viral Hepat 2014: 21: 917-20.
Xiao G, Yang J, Yan L. Comparison of diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis- 4 index for detecting liver fibrosis in adult patients with chronic hepatitis B virus infection: a systemic review and meta-analysis. Hepatology 2015: 61: 292-302.
Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, Lok AS. 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, M SS, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006: 43: 1317-25.
Park MS, Kim SW, Yoon KT, Kim SU, Park SY, Tak WY, Kweon YO, et al. Factors influencing the diagnostic accuracy of acoustic radiation force impulse elastography in patients with chronic hepatitis B. Gut and Liver 2016: 10: 275.
Liu Y, Yang G, Liu J, Yao S, Yuan J, Li S, Le X, et al. Optimal linear combination of ARFI, transient elastography and APRI for the assessment of fibrosis in chronic hepatitis B. Liver International 2015: 35: 816-25.
Xiao G, Yang J, Yan L. Comparison of diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis- 4 index for detecting liver fibrosis in adult patients with chronic hepatitis B virus infection: A systemic review and meta-analysis. Hepatology 2015: 61: 292-302.
Jin W, Lin Z, Xin Y, Jiang X, Dong Q, Xuan S. Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis B-related fibrosis: a leading meta-analysis. BMC Gastroenterology 2012: 12: 14.
Friedrich-Rust M, Buggisch P, Knegt Rd, Dries V, Shi Y, Matschenz K, Schneider M, et al. Acoustic radiation force impulse imaging for non-invasive assessment of liver fibrosis in chronic hepatitis B. J Viral Hepat 2013: 20: 240-7.
Enomoto M, Morikawa H, Tamori A, Kawada N. Noninvasive assessment of liver fibrosis in patients with chronic hepatitis B. World J Gastroenterol WJG 2014: 20: 12031.
Tai D-I, Tsay P-K, Jeng W-J, Weng C-C, Huang S-F, Huang C-H, Lin S-M, et al. Differences in Liver Fibrosis Between Patients With Chronic Hepatitis B and C. J Ultrasound Med 2015: 34: 813-21.
Bedossa P, Dargère D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology 2003: 38: 1449-57.
Poynard T, Halfon P, Castera L, Charlotte F, Bail B, Munteanu M, Messous D, et al. Variability of the area under the receiver operating characteristic curves in the diagnostic evaluation of liver fibrosis markers: impact of biopsy length and fragmentation. Alimentary Pharmacology & Therapeutics 2007: 25: 733-9.
Rousselet MC, Michalak S, Dupré F, Croué A, Bedossa P, Saint- André JP, Calès P. Sources of variability in histological scoring of chronic viral hepatitis. Hepatology 2005: 41: 257-64.