Validation of FIB-4 and comparison with other simple noninvasive indices for predicting liver fibrosis and cirrhosis in hepatitis B virus-infected patients

Beom Kyung Kim, Do Young Kim, Jun Yong Park, Sang Hoon Ahn, Chae Yoon Chon, Ja Kyung Kim, Yong Han Paik, Kwan Sik Lee, Young Nyun Park, Kwang Hyub Han

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Backgrounds:: To optimize management and predict long-term clinical courses in patients with chronic hepatitis B (CHB), noninvasive tests to determine the degree of hepatic fibrosis have been developed. Aims:: This study aimed to validate a simple, noninvasive FIB-4 index, which was first derived from an HCV-HIV-co-infected population, in patients with CHB and to compare it with other noninvasive tests for predicting cirrhosis. Methods:: From 2006-2008, a total of 668 consecutive CHB patients who underwent liver biopsies were enrolled. The fibrosis stage was assessed according to the Batts and Ludwig system by a single pathologist blinded to patients' data. Results:: For prediction of significant (F≥2) and severe (F≥3) fibrosis, and cirrhosis (F=4), the area under the receiver-operating characteristic curves were 0.865, 0.910 and 0.926 respectively. In predicting cirrhosis, it demonstrated diagnostic values comparable to the age-spleen platelet ratio index (0.937, P=0.414) and age-platelet index (0.928, P=0.888), and better outcomes than spleen-platelet ratio index (0.882, P=0.007), aspartate aminotransferase (AST)-platelet ratio index (0.731, P<0.001) and AST-alanine aminotransferase ratio index (0.730, P<0.001). FIB-4 cut-offs of 1.6 and 3.6 provided 93.2% negative predictive value and 90.8% positive predictive value for detection of cirrhosis respectively. Based on these results, liver biopsy could be avoided in 70.5% of the study population. These cut-offs were validated internally using bootstrap resampling methods, showing good agreement. Conclusions:: FIB-4 is a simple, accurate and inexpensive method of predicting cirrhosis, with outcomes comparable to other noninvasive tests and may reduce the need for liver biopsy in the majority of CHB patients.

Original languageEnglish
Pages (from-to)546-553
Number of pages8
JournalLiver International
Volume30
Issue number4
DOIs
Publication statusPublished - 2010 Apr 1

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Hepatitis B virus
Liver Cirrhosis
Fibrosis
Chronic Hepatitis B
Blood Platelets
Liver
Aspartate Aminotransferases
Biopsy
Spleen
Alanine Transaminase
ROC Curve
Population
HIV

All Science Journal Classification (ASJC) codes

  • Hepatology

Cite this

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title = "Validation of FIB-4 and comparison with other simple noninvasive indices for predicting liver fibrosis and cirrhosis in hepatitis B virus-infected patients",
abstract = "Backgrounds:: To optimize management and predict long-term clinical courses in patients with chronic hepatitis B (CHB), noninvasive tests to determine the degree of hepatic fibrosis have been developed. Aims:: This study aimed to validate a simple, noninvasive FIB-4 index, which was first derived from an HCV-HIV-co-infected population, in patients with CHB and to compare it with other noninvasive tests for predicting cirrhosis. Methods:: From 2006-2008, a total of 668 consecutive CHB patients who underwent liver biopsies were enrolled. The fibrosis stage was assessed according to the Batts and Ludwig system by a single pathologist blinded to patients' data. Results:: For prediction of significant (F≥2) and severe (F≥3) fibrosis, and cirrhosis (F=4), the area under the receiver-operating characteristic curves were 0.865, 0.910 and 0.926 respectively. In predicting cirrhosis, it demonstrated diagnostic values comparable to the age-spleen platelet ratio index (0.937, P=0.414) and age-platelet index (0.928, P=0.888), and better outcomes than spleen-platelet ratio index (0.882, P=0.007), aspartate aminotransferase (AST)-platelet ratio index (0.731, P<0.001) and AST-alanine aminotransferase ratio index (0.730, P<0.001). FIB-4 cut-offs of 1.6 and 3.6 provided 93.2{\%} negative predictive value and 90.8{\%} positive predictive value for detection of cirrhosis respectively. Based on these results, liver biopsy could be avoided in 70.5{\%} of the study population. These cut-offs were validated internally using bootstrap resampling methods, showing good agreement. Conclusions:: FIB-4 is a simple, accurate and inexpensive method of predicting cirrhosis, with outcomes comparable to other noninvasive tests and may reduce the need for liver biopsy in the majority of CHB patients.",
author = "Kim, {Beom Kyung} and Kim, {Do Young} and Park, {Jun Yong} and Ahn, {Sang Hoon} and Chon, {Chae Yoon} and Kim, {Ja Kyung} and Paik, {Yong Han} and Lee, {Kwan Sik} and Park, {Young Nyun} and Han, {Kwang Hyub}",
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Validation of FIB-4 and comparison with other simple noninvasive indices for predicting liver fibrosis and cirrhosis in hepatitis B virus-infected patients. / Kim, Beom Kyung; Kim, Do Young; Park, Jun Yong; Ahn, Sang Hoon; Chon, Chae Yoon; Kim, Ja Kyung; Paik, Yong Han; Lee, Kwan Sik; Park, Young Nyun; Han, Kwang Hyub.

In: Liver International, Vol. 30, No. 4, 01.04.2010, p. 546-553.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Validation of FIB-4 and comparison with other simple noninvasive indices for predicting liver fibrosis and cirrhosis in hepatitis B virus-infected patients

AU - Kim, Beom Kyung

AU - Kim, Do Young

AU - Park, Jun Yong

AU - Ahn, Sang Hoon

AU - Chon, Chae Yoon

AU - Kim, Ja Kyung

AU - Paik, Yong Han

AU - Lee, Kwan Sik

AU - Park, Young Nyun

AU - Han, Kwang Hyub

PY - 2010/4/1

Y1 - 2010/4/1

N2 - Backgrounds:: To optimize management and predict long-term clinical courses in patients with chronic hepatitis B (CHB), noninvasive tests to determine the degree of hepatic fibrosis have been developed. Aims:: This study aimed to validate a simple, noninvasive FIB-4 index, which was first derived from an HCV-HIV-co-infected population, in patients with CHB and to compare it with other noninvasive tests for predicting cirrhosis. Methods:: From 2006-2008, a total of 668 consecutive CHB patients who underwent liver biopsies were enrolled. The fibrosis stage was assessed according to the Batts and Ludwig system by a single pathologist blinded to patients' data. Results:: For prediction of significant (F≥2) and severe (F≥3) fibrosis, and cirrhosis (F=4), the area under the receiver-operating characteristic curves were 0.865, 0.910 and 0.926 respectively. In predicting cirrhosis, it demonstrated diagnostic values comparable to the age-spleen platelet ratio index (0.937, P=0.414) and age-platelet index (0.928, P=0.888), and better outcomes than spleen-platelet ratio index (0.882, P=0.007), aspartate aminotransferase (AST)-platelet ratio index (0.731, P<0.001) and AST-alanine aminotransferase ratio index (0.730, P<0.001). FIB-4 cut-offs of 1.6 and 3.6 provided 93.2% negative predictive value and 90.8% positive predictive value for detection of cirrhosis respectively. Based on these results, liver biopsy could be avoided in 70.5% of the study population. These cut-offs were validated internally using bootstrap resampling methods, showing good agreement. Conclusions:: FIB-4 is a simple, accurate and inexpensive method of predicting cirrhosis, with outcomes comparable to other noninvasive tests and may reduce the need for liver biopsy in the majority of CHB patients.

AB - Backgrounds:: To optimize management and predict long-term clinical courses in patients with chronic hepatitis B (CHB), noninvasive tests to determine the degree of hepatic fibrosis have been developed. Aims:: This study aimed to validate a simple, noninvasive FIB-4 index, which was first derived from an HCV-HIV-co-infected population, in patients with CHB and to compare it with other noninvasive tests for predicting cirrhosis. Methods:: From 2006-2008, a total of 668 consecutive CHB patients who underwent liver biopsies were enrolled. The fibrosis stage was assessed according to the Batts and Ludwig system by a single pathologist blinded to patients' data. Results:: For prediction of significant (F≥2) and severe (F≥3) fibrosis, and cirrhosis (F=4), the area under the receiver-operating characteristic curves were 0.865, 0.910 and 0.926 respectively. In predicting cirrhosis, it demonstrated diagnostic values comparable to the age-spleen platelet ratio index (0.937, P=0.414) and age-platelet index (0.928, P=0.888), and better outcomes than spleen-platelet ratio index (0.882, P=0.007), aspartate aminotransferase (AST)-platelet ratio index (0.731, P<0.001) and AST-alanine aminotransferase ratio index (0.730, P<0.001). FIB-4 cut-offs of 1.6 and 3.6 provided 93.2% negative predictive value and 90.8% positive predictive value for detection of cirrhosis respectively. Based on these results, liver biopsy could be avoided in 70.5% of the study population. These cut-offs were validated internally using bootstrap resampling methods, showing good agreement. Conclusions:: FIB-4 is a simple, accurate and inexpensive method of predicting cirrhosis, with outcomes comparable to other noninvasive tests and may reduce the need for liver biopsy in the majority of CHB patients.

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