@article{e0386934b0f249dbb18d01513f31da07,
title = "Evaluation of APRI and FIB-4 scoring systems for non-invasive assessment of hepatic fibrosis in chronic hepatitis B patients",
abstract = "Background & Aims While the gold standard in the assessment of liver fibrosis remains liver biopsy, non-invasive methods have been increasingly used for chronic hepatitis B (CHB). This study aimed to evaluate the performance of two commonly used non-invasive scoring systems (aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4)) to predict fibrosis stage in CHB patients. Methods Demographic, histologic and clinical laboratory data from two trials investigating tenofovir disoproxil fumarate in CHB were analyzed. Predicted fibrosis stage, based on established scales and cut-off values for APRI and FIB-4 scores, was compared with Ishak scores obtained from liver biopsy at baseline and at 240 week follow-up. Results In the 575 patients with a baseline liver biopsy, APRI and FIB-4 scores correlated with Ishak stage (p <0.01); however extensive overlap in the distribution of both scores across Ishak stages prevented accurate determination of fibrosis. The majority (81-89%) of patients with advanced fibrosis or cirrhosis were missed by the scores. Similarly, 71% patients without fibrosis were misclassified as having clinically significant fibrosis. APRI and FIB-4 scores at week 240 tended to be low and underestimate fibrosis stage in the patients with liver biopsies after 240 weeks of therapy. APRI or FIB-4 reduction did not correlate with fibrosis regression after 240 weeks of antiviral therapy. Conclusions APRI and FIB-4 scores are not suitable for use in clinical practice in CHB patients for assessment of hepatic fibrosis according to Ishak stage, especially in gauging improvements in liver fibrosis following therapy.",
keywords = "APRI, Chronic hepatitis B, FIB-4, Fibrosis",
author = "{Ray Kim}, W. and Thomas Berg and Tarik Asselah and Robert Flisiak and Scott Fung and Gordon, {Stuart C.} and Janssen, {Harry L.A.} and Pietro Lampertico and Daryl Lau and Bornstein, {Jeffrey D.} and Schall, {Raul E.Aguilar} and Phillip Dinh and Yee, {Leland J.} and Martins, {Eduardo B.} and Lim, {Seng Gee} and Rohit Loomba and J{\"o}rg Petersen and Maria Buti and Patrick Marcellin",
note = "Funding Information: This study was supported by Gilead Sciences, Inc. Literature review, reference management and editorial assistance were provided by Claire Demenis, PhD and Liesje Quine, PhD (Elements Communications Ltd, Westerham, UK), funded by Gilead Sciences, Inc. The final manuscript is a product by the authors in its entirety and theirs only. Funding Information: W. Ray Kim, MD, Advisory Board for AbbVie, Gilead Sciences and MSD. Consultant for BMS; Thomas Berg, MD, Grants and consulting fees from BMS and Gilead. Board member, lecturer and consultant for AbbVie, Janssen and MSD. Grants from Janssen;Tarik Asselah, MD, Advisory Board and Speaker Bureau for BMS, Gilead Sciences and Roche; Robert Flisiak, MD, Board member and consultant for AbbVie, BMS, Gilead Sciences, Janssen, MSD and Roche. Consultant for GSK and Novartis. Speaker fees and expenses received from AbbVie, BMS, Gilead Sciences, Janssen, MSD and Roche; Scott Fung, MD, Consultant, advisor and speaker for AbbVie, BMS, Gilead Sciences, Janssen, MSD and Roche. Consultant and advisor for GSK; Stuart C. Gordon, MD, Grants and consulting fees from AbbVie, BMS, Gilead Sciences and MSD. Consulting fees from Achillon; Harry L.A. Janssen, MD, Consultancy with and research support from BMS, Gilead Sciences, Innogenetics, Merck, Novartis, and Roche; Pietro Lampertico, MD, Advisory Board and Speaker Bureau for BMS, Gilead Sciences, GSK, MSD and Roche; Daryl Lau, MD, Declares no conflicts of interest; Jeffrey D. Bornstein, MD, Stockholder and previous employee of Gilead Sciences; Raul E. Aguilar Schall, PhD, Employee and stockholder of Gilead Sciences; Phillip Dinh, PhD, Employee and stockholder of Gilead Sciences; Leland J. Yee, MD, Employee and stockholder of Gilead Sciences; Eduardo B. Martins, MD, DPhil, Employee and stockholder of Gilead Sciences; Seng Gee Lim, MD, Advisory Board member for Achillion, BMS, Boehringer Ingelheim, Gilead Sciences, Janssen, MSD and Roche. Speaker Bureau member for BMS, Boehringer Ingelheim, Gilead Sciences, GSK, MSD and Roche; Rohit Loomba, MD, Grants and consultancy fees received from Gilead Sciences; J{\"o}rg Petersen, MD, Worked with, and received grant or research support from AbbVie, BMS, Boehringer Ingelheim, Gilead Sciences, Janssen, Merck, MSD, Novartis, Roche, Siemens, and Vertex. Has also worked with Abbott, GlaxoSmithKline and Kedrion; Maria Buti, MD, Advisor and Speaker for BMS, Gilead Sciences and Novartis; Patrick Marcellin, MD, Worked with BMS, Gilead Sciences, Janssen-Tibotec, MSD, Novartis, Roche and Vertex. Investigator for Boehringer Ingelheim and Pfizer. Investigator and expert for Abbott. Investigator and received grant support from Alios BioPharma. Publisher Copyright: {\textcopyright} 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.",
year = "2016",
month = apr,
day = "1",
doi = "10.1016/j.jhep.2015.11.012",
language = "English (US)",
volume = "64",
pages = "773--780",
journal = "Journal of Hepatology",
issn = "0168-8278",
publisher = "Elsevier",
number = "4",
}