Re-determining the cut-off points of FIB-4 for patients monoinfected with chronic hepatitis B virus infection

Huseyin Kayadibi 1 , 2 , Bulent Yasar 3 , Selvinaz Ozkara 4 , Ugur Demirpek 5 , Metin Uyanik 6 , Erdim Sertoglu 7 , Fatih Ozcelik 7 , Can Gonen 8 ,  and Sebahat Aksaray 9
  • 1 Department of Medical Biochemistry, Hitit University School of Medicine, Corum, Turkey
  • 2 Department of Medical Biochemistry, Corum Training and Research Hospital, Corum, Turkey
  • 3 Department of Gastroenterohepatology, Baskent University Istanbul Medical and Research Center, Istanbul, Turkey
  • 4 Department of Medical Pathology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
  • 5 Department of Medical Microbiology, Tatvan State Hospital, Bitlis, Turkey
  • 6 Department of Medical Biochemistry, Corlu State Hospital, Tekirdag, Turkey
  • 7 Department of Medical Biochemistry, Haydarpasa Sultan Abdulhamid Training and Research Hospital, Istanbul, Turkey
  • 8 Department of Gastroenterohepatology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
  • 9 Department of Medical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
Huseyin Kayadibi, Bulent Yasar, Selvinaz Ozkara, Ugur Demirpek, Metin Uyanik, Erdim Sertoglu, Fatih Ozcelik, Can Gonen and Sebahat Aksaray

Abstract

Objective:

This study aimed to determine significant liver fibrosis and cirrhosis with different FIB-4 cut-off points, and the need for liver biopsy (LB) by optimizing the initially established cut-off points of 1.45 and 3.25.

Materials and methods:

The study included 201 patients monoinfected with chronic HBV. METAVIR classification was used to determine the stage of fibrosis. ROC analysis and the Youden index were performed to define the optimum cut-off points.

Results:

A FIB-4 cut-off point of 1.45 and 1.62 generated Youden indexes of 0.51 and 0.55, the accuracy of 78.6% and 81.1% for significant liver fibrosis, respectively. The FIB-4 cut-off was set at 2.40 and 3.25 Youden indexes were 0.46 and 0.16, accuracies were 79.6% and 69.7% for significant liver fibrosis, respectively. A cut-off point of 1.45 and 1.62 for FIB-4 generated Youden indexes of 0.62 and 0.66, the accuracies of 81.6% and 84.1% for cirrhosis, while the FIB-4 cut-off point of 2.40 and 3.25 generated Youden indexes of 0.59 and 0.22, with the accuracies of 90% and 84.1% for cirrhosis, respectively.

Conclusions:

The FIB-4 cut-off points of 1.62 and 2.40 have higher accuracy and may decrease the need for LB 12% more than the initially established ones in HBV monoinfected patients.

  • 1.

    Kim BK, Kim DY, Park JY, Ahn SH, Chon CY, Kim JK, et al. Validation of FIB-4 and comparison with other simple non-invasive indices for predicting liver fibrosis and cirrhosis in hepatitis B virus-infected patients. Liver Int 2010;30:546–53.

    • Crossref
    • Export Citation
  • 2.

    Poynard T, Ngo Y, Perazzo H, Munteanu M, Lebray P, Moussalli J, et al. Prognostic value of liver fibrosis biomarkers: a meta-analysis. Gastroenterol Hepatol (NY) 2011;7:445–54.

  • 3.

    Colloredo G, Guido M, Sonzogni A, Leandro G. Impact of liver biopsy size on histological evaluation of chronic viral hepatitis: the smaller the sample, the milder the disease. J Hepatol 2003;39:239–44.

    • Crossref
    • PubMed
    • Export Citation
  • 4.

    Tobkes AI, Nord HJ. Liver biopsy: review of methodology and complications. Dig Dis 1995;13:267–74.

    • Crossref
    • PubMed
    • Export Citation
  • 5.

    Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001;344:495–500.

    • Crossref
    • PubMed
    • Export Citation
  • 6.

    Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006;43:1317–25.

    • Crossref
    • PubMed
    • Export Citation
  • 7.

    Youden WJ. Index for rating diagnostic tests. Cancer 1950;3:32–5.

    • Crossref
    • PubMed
    • Export Citation
  • 8.

    Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology 1996;24:289–93.

    • Crossref
    • Export Citation
  • 9.

    Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD. American association for the study of liver diseases. Liver biopsy. Hepatology 2009;49:1017–44.

  • 10.

    Regev A, Berho M, Jeffers LJ, Milikowski C, Molina EG, Pyrsopoulos NT, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002;97:2614–18.

    • Crossref
    • PubMed
    • Export Citation
  • 11.

    Yuen MF, Yuan HJ, Wong DK, Yuen JC, Wong WM, Chan AO, et al. Prognostic determinants for chronic hepatitis B in Asians: therapeutic implications. Gut 2005;54:1610–4.

    • Crossref
    • PubMed
    • Export Citation
  • 12.

    Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. comparison with liver biopsy and fibrotest. Hepatology 2007;46:32–6.

    • Crossref
    • PubMed
    • Export Citation
  • 13.

    Tamaki N, Kurosaki M, Tanaka K, Suzuki Y, Hoshioka Y, Kato T, et al. Noninvasive estimation of fibrosis progression overtime using the FIB-4 index in chronic hepatitis C. J Viral Hepat 2013;20:72–6.

    • Crossref
    • PubMed
    • Export Citation
  • 14.

    Li Y, Chen Y, Zhao Y. The diagnostic value of the FIB-4 index for staging hepatitis B-related fibrosis: a meta-analysis. PLoS One 2014;9:e105728.

    • Crossref
    • PubMed
    • Export Citation
  • 15.

    Kim WR, Berg T, Asselah T, Flisiak R, Fung S, Gordon SC, et al. Evaluation of APRI and FIB-4 scoring systems for non-invasive assessment of hepatic fibrosis in chronic hepatitis B patientsq. J Hepatol 2016;64:773–80.

    • Crossref
    • PubMed
    • Export Citation
  • 16.

    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.

    • Crossref
    • PubMed
    • Export Citation
Purchase article
Get instant unlimited access to the article.
$42.00
Log in
Already have access? Please log in.


or
Log in with your institution

Journal + Issues

Turkish Journal of Biochemistry (TJB), official journal of Turkish Biochemical Society, is issued electronically every 2 months. The main aim of the journal is to support the research and publishing culture by ensuring that every published manuscript has an added value and thus providing international acceptance of the “readability” of the manuscripts published in the journal.

Search