Evaluation of diagnostic performance simple non-invasıve fibrosis markers in patients with chronic hepatitis B

INTRODUCTION: Determining stage of liver fibrosis is crucical for timing of theraphy in chronic hepatitis b (CHB) patients. Also it is important predictor of disease prognosis and response to treatment. Although liver biopsy is the gold standard for demonstrating fibrosis stage, non-invasive fibrosis markers may be useful as an alternative method due to their simply, non invasiveness. In this study, we aimed to investigate the diagnostic performance of eight non-invasive fibrosis markers in the diagnosis of significant fibrosis and cirrhosis with reference to liver biopsy. METHODS: Naive, consecutive chronic hepatitis B patients who performed liver biyopsy last five years were screened retrospectively. Aspartate transaminase to-platelet ratio index (APRI), fibrosis index based on four factors (FIB-4), aspartate transaminase to alanin transaminase ratio (AAR), APGA model, Fibro-quotient (FibroQ), platelet-age-phosphatase-alpha fetoprotein- aspartate transaminase (PAPAS) index, gama glutamyl transferase to platelet ratio (GPR) and S- index were calculated by using biochemical blood test parametrs that obtained within one month before the liver biopsy. Diagnostic performance each index with receiver operating characteristic (ROC) analysis were assesed for diagnosing significant fibrosis (≥ F3) and cirrhosis (≥F5, according the ISHAC scoring system).  RESULTS: Patients who also have diagnosis other liver disease (autoimmun hepatitis, hepatitis C, alcholic hepatitis, delta hepatitis), few than six portal tact on liver biopsy and insufficient biochemical data for calculating non invasive scores were excluded. 417 patients inculded in study. 161 (38.6%) of the patients were Female and 256 (61.4%) were Male. The mean age of the patients was 42.26 ± 11.88. Histopathologic examination revealed significant fibrosis in 221 (52.7%) patients, advanced fibrosis in 80 (19.1%), and cirrhosis in 29 (6.9%). AUROC value S-index, GPR, APRI, Fib-4 index, FibroQ and PAPAS for diagnosing signifcant fibroisis were 0.683, 0.667, 0.679, 0.679, 0.585, 0.606 respectively. AUROC value APRI, Fib-4 index, FibroQ, PAPAS, APRI, FibroQ, PAPAS for diagnosing cirrhosis were 0.841, 0.819, 0.833, 0.802, 0.767, 0.620, 0.700, 0.697 respectively. CONCLUSION: According to the results of this study, the diagnostic performance of S-index in the diagnosis of significant fibrosis and cirrhosis in patients CHB infection was found better than GPR APRI, Fib-4 index, FibroQ, PAPAS, AAR, APGA and FI indices. We think that S index may be useful for determining cirrhosis, but it has limited value in determining significant fibrosis as other indices due to low AUROC value.