Prospective Evaluation of FibroScan for the Diagnosis of Hepatic Fibrosis Compared with Liver Biopsy/AST Platelet Ratio Index and FIB-4 in Patients with Chronic HBV Infection

Background The FibroScan (FS), the aspartate aminotransferase-to-platelet ratio index (APRI), and the FIB-4 index are simple and inexpensive methods to detect liver fibrosis. Aims The primary objective was to evaluate the performance of FS for the noninvasive diagnosis of hepatic fibrosis in Western Chinese patients with chronic hepatitis B virus (HBV) infection compared with APRI and FIB-4; the secondary objective was to determine liver stiffness measurement (LSM) cutoff values for the noninvasive diagnosis of significant fibrosis and liver cirrhosis. Methods Overall, 175 consecutive patients with chronic HBV infection, successful liver biopsy, and alanine aminotransferase levels a parts per thousand currency sign2x ULN were prospectively studied. Liver fibrosis was graded by an independent pathologist using the METAVIR (F0-F4) classification. APRI and FIB-4 were calculated from laboratory data. Results The area under receiver operating characteristics curves (AUROC) for LSM for significant fibrosis (METAVIR F2-3) and cirrhosis (F4) was 0.95 (95% confidence interval, 0.91-0.98) and 0.98 (0.96-0.99), respectively. For the detection of significant fibrosis and cirrhosis, the AUROC of APRI were 0.81 (0.74-0.87) and 0.83 (0.77-0.90); the AUROC of FIB-4 were 0.86 (0.80-0.91) and 0.77 (0.68-0.85). FS optimal cutoff values for the identification of significant fibrosis and cirrhosis were 7.9 and 13.8 kPa, respectively. Conclusions FS is a reliable predictor of significant fibrosis and cirrhosis in Western Chinese patients with chronic HBV infection, and is superior to APRI and FIB-4. FS cutoff values could be considered as clinical reference for detecting significant fibrosis and cirrhosis.