Comparison of FIB-4 and APRI indices as a non-invasive markers for fibrosis in chronic HCV infection

Background and Aim: To assess the value of FIB-4 to both AAR and APRI indexes and their values to differentiate mild to moderate fibrosis from advanced fibrosis in HCV genotype 4-infected Egyptian patients in comparison to liver biopsy. Methods: 202 genotype 4 HCV-infected Egyptian patients were included. Results: There was a significant relationship between fibrosis stages and serum indices except AAR. A gradual increase in the level of FIB-4, AAR and APRI indices were observed with advancement of the fibrosis stages. The FIB-4 score had the best diagnostic accuracy for advanced fibrosis followed by AAR, and APRI. As the NPV for FIB-4 score is 90% using the lower cut-off, this test may have sufficient accuracy to be used clinically to exclude advanced fibrosis. Conclusion: FIB-4 index is a noninvasive test for the assessment of liver fibrosis. It is more sensitive and accurate than both AAR and APRI in defining the degree of fibrosis. It can be used efficiently in cases of chronic HCV mono infection. A score of <1.26 and >2.1 enables the correct identification of patients with HCV infection genotype 4 who have significant fibrosis and could avoid liver biopsy examination in 65.8% of cases. Because the FIB-4 index is readily available, inexpensive, and reproducible, it could replace expensive and/or invasive methods to assess liver fibrosis, especially in developing countries, to detect patients who need antiviral treatment and to monitor liver fibrosis progression or regression.