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Diagnostic performance of APRI, RPR, FIB-4, GPR, AAR, and NLR in assessing the degree of liver fibrosis in patients with chronic hepatitis B

  • Cokorde Istri Yuliandari Krisnawardani Kumbara ,
  • I Dewa Nyoman Wibawa ,
  • I Gde Somayana ,
  • I Gusti Agung Suryadarma ,
  • I Ketut Mariadi ,


Abstract

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.

Keywords: Biomarkers transient elastography hepatitis B liver cirrhosis
Section

References

  1. Guidelines for the Prevention, Care and Treatment of Persons with Chronic Hepatitis B Infection. Geneva: World Health Organization; March 2015.
  2. Mehta SH, Lau B, Afdhal NH, Thomas DL. Exceeding the limits of liver histology markers. J Hepatol. 2009;50(1):36–41.
  3. Shiha G, Ibrahim A, Helmy A, Sarin SK, Omata M, Kumar A, et al. Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update. Hepatol Int. 2017;11(1):1-30.
  4. Xu X, Su Y, Song R, Sheng Y, Ai W, Wu X, et al. Performance of transient elastography assessing fibrosis of single hepatitis B virus infection: A systematic review and meta-analysis of a diagnostic test. Hepatol Int. 2015;9(4):558–66.
  5. Biyik M, Ucar R, Solak Y, Gungor G, Polat I, Gaipov A, et al. Blood neutrophil-to-lymphocyte ratio independently predicts survival in patients with liver cirrhosis. 2011;435–41.
  6. Fung J, Lai C, Cheng C, Wu R, Wong DK, Yuen M. Mild-to-moderate elevation of alanine aminotransferase increases liver stiffness measurement by transient elastography in patients with chronic hepatitis B. Am J Gastroenterol. 2010;106(3):492–6.
  7. Milas GP, Karageorgiou V, Cholongitas E. Red cell distribution width to platelet ratio for liver fibrosis: A systematic review and meta-analysis of diagnostic accuracy. Expert Rev Gastroenterol Hepatol. 2019;0(0):1–15.
  8. Castera L, Forns X, Alberti A. Noninvasive evaluation of liver fibrosis using transient elastography q. 2008;48:835–47.
  9. Giannini E, Risso D, Botta F, Chiarbonello B, Fasoli A, Malfatti F, et al. Validity and clinical utility of the aspartate aminotransferase-alanine aminotransferase ratio in assessing disease severity and prognosis in patients with hepatitis C virus-related chronic liver disease. Arch Intern Med. 2003;163(2):218-224.
  10. Lemoine M, Shimakawa Y, Nayagam S, Khalil M, Suso P, Lloyd J, et al. The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa. Gut. 2016;1369–76.
  11. Chen B, Ye B, Zhang J, Ying L, Chen Y. RDW to platelet ratio: A novel noninvasive index for predicting hepatic fibrosis and cirrhosis in chronic hepatitis B. PLoS One. 2013;8(7):1–8.
  12. Huang R, Wang G, Tian C, Liu Y, Jia B, Wang J, et al. Gamma-glutamyl-Transpeptidase to platelet ratio is not superior to APRI, FIB-4 and RPR for diagnosing liver fibrosis in CHB patients in China. Sci Rep. 2017;7(1):1–10.
  13. Zhu MY, Zou X, Li Q, Yu DM, Yang ZT, Huang D, et al. A novel noninvasive algorithm for the assessment of liver fibrosis in patients with chronic hepatitis B virus infection. J Viral Hepat. 2017;24(7):589–98.
  14. Xiao G, Yang J, Yan L. Comparison of diagnostic accuracy of APRI and FIB-4 for detecting liver fibrosis in adult patients with CHB: A systemic review and meta-analysis. Hepatology. 2015;61:292–302.
  15. Chen YP, Hu XM, Liang XE, Huang LW, Zhu YF, Hou JL. Stepwise application of fibrosis index based on four factors, red cell distribution width–platelet ratio, and aspartate aminotransferase–platelet ratio for compensated hepatitis B fibrosis detection. J Gastroenterol Hepatol. 2018;33(1):256–63.
  16. Habibzadeh F, Habibzadeh P, Yadollahie M. On determining the most appropriate test cut-off value: The case of tests with continuous results. Biochem Med (Zagreb). 2016;26(3):297-307.
  17. Li Q, Song J, Huang Y, Li X, Zhuo Q, Li W, Chen C, Lu C, Qi X, Chen L. The gamma-glutamyl-transpeptidase to platelet ratio does not show advantages than APRI and FIB-4 in diagnosing significant fibrosis and cirrhosis in patients with chronic hepatitis B: A retrospective cohort study in China. Medicine (Baltimore). 2016;95(16):e3372.
  18. Lee J, Kim MY, Kang SH, Kim J, Uh Y, Yoon KJ, Kim HS. The gamma-glutamyl transferase to platelet ratio and the FIB-4 score are noninvasive markers to determine the severity of liver fibrosis in chronic hepatitis B infection. Br J Biomed Sci. 2018;75(3):128-132.
  19. Ren T, Wang H, Wu R, Niu J. Gamma-glutamyl transpeptidase-to-platelet ratio predicts significant liver fibrosis of chronic hepatitis B patients in China. Gastroenterol Res Pract. 2017;2017:7089702.
  20. Lian MJ, Zhang JQ, Chen SD, Zhang DD, Yang YY, Hong GL. Diagnostic accuracy of γ-glutamyl transpeptidase-to-platelet ratio for predicting hepatitis B-related fibrosis: A meta-analysis. Eur J Gastroenterol Hepatol. 2019;31(5):599-606.
  21. Kasarala G, Tillmann HL. Standard liver tests. Clin Liver Dis (Hoboken). 2016;8(1):13-18.
  22. Kunutsor SK. Gamma-glutamyltransferase-friend or foe within? Liver Int. 2016 Dec;36(12):1723-1734.
  23. Akcay IM, Katrinli S, Ozdil K, Doganay GD, Doganay L. Host genetic factors affecting hepatitis B infection outcomes: Insights from genome-wide association studies. World J Gastroenterol. 2018;24(30):3347-3360.

How to Cite

Kumbara, C. I. Y. K., Wibawa, I. D. N., Somayana, I. G., Suryadarma, I. G. A., & Mariadi, I. K. (2020). Diagnostic performance of APRI, RPR, FIB-4, GPR, AAR, and NLR in assessing the degree of liver fibrosis in patients with chronic hepatitis B. Indonesia Journal of Biomedical Science, 14(2), 122–127. https://doi.org/10.15562/ijbs.v14i2.276
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Cokorde Istri Yuliandari Krisnawardani Kumbara
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Pubmed
IJBS Journal

I Dewa Nyoman Wibawa
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IJBS Journal

I Gde Somayana
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IJBS Journal

I Gusti Agung Suryadarma
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I Ketut Mariadi
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IJBS Journal