Background: This study aimed to compare the diagnostic performance of aspartate aminotransferase to platelet ratio index (APRI), fibrosis index based on four factors (FIB-4), red cell distribution width to platelet ratio (RPR), gamma-glutamyl transpeptidase to platelet ratio (GPR), aspartate aminotransferase and alanine aminotransferase ratio (AAR), and neutrophil to lymphocyte ratio (NLR) in assessing the degree of liver fibrosis in patients with chronic hepatitis B.
Methods: A cross-sectional analytic study was done to analyze the data taken from the medical records of all chronic hepatitis B patients examined using TE at Sanglah Hospital Denpasar, Bali. Receiver operating characteristic (ROC) curve analysis was done to compare the resulting indices of accuracy for each biomarker.
Results: From the total of 93 samples, it was found that the number of samples for each degree of fibrosis was 42 (45.16%) F0-1, 17 (18.27%) F2, 7 (7.52%) F3, and 27 (29.03%) F4. Significant differences for each degree of fibrosis (p<0.005) were found in APRI, FIB-4, RPR, GPR, and AAR score but not NLR (p = 0.897). Higher AUC and indices of accuracy were observed with more severe degree of fibrosis. GPR with the cut-off value of 0.367 for significant fibrosis, 0.559 for severe fibrosis, and 0.698 for cirrhosis had the greatest AUC and diagnostic accuracy.
Conclusion: The diagnostic performance of GPR was better than other biomarkers, and the diagnostic accuracy increased along with an increasing degree of fibrosis. Future study on the applicability of GPR alongside APRI and FIB-4 in liver fibrosis assessment is needed.