Original Articles

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, Anak Agung Istri Sri Kumala Dewi, I Ketut Mariadi, I Gde Somayana, I Gusti Agung Suryadarma

Cokorde Istri Yuliandari Krisnawardani Kumbara
Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Universitas Udayana Hospital, Badung, Bali, Indonesia. Email: krisnawardani@unud.ac.id

I Dewa Nyoman Wibawa
Division of Gastroenterohepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Badung, Bali, Indonesia

Anak Agung Istri Sri Kumala Dewi
Department of Internal Medicine, Wangaya Regional General Hospital, Bali Indonesia

I Ketut Mariadi
Division of Gastroenterohepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Badung, Bali, Indonesia

I Gde Somayana
Division of Gastroenterohepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Badung, Bali, Indonesia

I Gusti Agung Suryadarma
Division of Gastroenterohepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Badung, Bali, Indonesia
Online First: December 01, 2020 | Cite this Article
Kumbara, C., Wibawa, I., Dewi, A., Mariadi, I., Somayana, I., Suryadarma, I. 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. DOI:10.15562/ijbs.v14i2.276


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.

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