Non-Invasive Diagnosis of Liver Fibrosis and Cirrhosis: Role of Apri, Fib-4 and its Correlation with Liver Stiffness Measurements (LSM) by Fibroscan

Author(s): Dr. Palabatla Rahul, Dr. Smitha. K, Dr. MGK Pillai and Renjitha Bhaskaran

Background: Liver fibrosis and liver cirrhosis represent a major health care burden. Liver fibrosis is the excessive accumulation of extracellular matrix proteins like collagen that occurs in most types of chronic liver diseases. This study was done to assess role of non-invasive diagnosis of liver fibrosis. APRI and FIB-4 are two simple, easy to calculate indices which are used in the diagnosis of liver fibrosis. Methods: This study included 143 patients who presented to Medicine and Gastroenterology OP and were advised fibro scan for the evaluation of liver fibrosis. Age of the patient, platelet counts, AST, ALT, viral markers (HbsAg, Anti-HCV), history of alcohol consumption, Ultrasound abdomen and pelvis, Liver stiffness measurements (LSM) values by fibro scan (elastography) are collected. APRI and FIB-4 was calculated and compared with that of fibro scan (Elastography). Results: Statistical analysis was performed using IBM SPSS version 20.0 software. To test the statistical significance of the difference in the findings of APRI and FIB with elastography, McNemar’s Chi-square test was used. The results showed there is statistically no significant difference between FIB-4 values and elastography findings (p value = 1.00) with sensitivity of 82.5% and specificity 89.5%. Whereas, APRI did not co-relate with fibroscan. But when the patients were classified based on aetiology of liver fibrosis, both APRI and FIB-4 performed well in patients with NAFLD, Chronic Hepatitis B and C. FIB-4 performed well in patients with Alcoholic Liver Disease also. Conclusion: APRI and FIB-4 are valuable non- invasive markers in assessment of fibrosis of liver. Overall, when compared to elastography values, FIB-4 was better than APRI in predicting early fibrosis of liver. In primary centres where elastography is not available, APRI and FIB-4 act as an important aid for assessing fibrosis of liver

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