Resumen

Introduction: Although it is standard procedure in the evaluation of liver diseases, biopsy is an invasive method subject to sampling error and intra or inter-observer variability. Thus, surrogate markers of liver fibrosis have been proposed, with variable availability and accuracy. Aim: Validate and compare the performance of APRI and FIB-4 as predictors of liver fibrosis in HCV patients. Material and methods: Crosssectional study including patients with HCV-RNA (+) who underwent liver biopsy. Significant fibrosis was defined as METAVIR stage > 2. The diagnostic performance of the models in predicting significant fibrosis were evaluated and compared by ROC curves. Results: The study included 119 patients, mean age 43.7 + 10.6 years and 62% males. Significant fibrosis was identified in 41 patients. The AUROCs observed were: APRI = 0.793 + 0.047, FIB-4 = 0.811 + 0.045 and AST/ALT = 0.661 ± 0.055 (P = 0.054 for APRI vs. AST/ALT, and P = 0.014 for FIB-4 vs. AST/ALT). Considering classic cutoffs, the PPV and NPV for APRI and FIB-4 were, respectively, 77% and 92% and 83% and 81%. Thirteen (19%) patients were misdiagnosed by APRI and 16 (18%) by FIB-4. By restricting the indication of liver biopsy to patients with intermediate values, it could have been correctly avoided in 47% and 63% of the patients with APRI and FIB-4, respectively. Conclusion: The models APRI and FIB-4 were superior to AST/ALT ratio in the diagnosis of significant fibrosis in chronic HCV infection. Even though the overall performance of APRI and FIB-4 was similar, a higher proportion of patients may be correctly classified by FIB-4.

Palabras clave: Liver cirrhosis biomarkers diagnosis.

2012-11-14   |   727 visitas   |   Evalua este artículo 0 valoraciones

Vol. 11 Núm.6. Noviembre-Diciembre 2012 Pags. 855-861 Ann Hepatol 2012; 11(6)