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Applicability of APRI and FIB-4 as a transition indicator of liver fibrosis in patients with chronic viral hepatitis

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background and Aims

The usefulness of APRI or FIB-4 is well established as a non-invasive liver fibrosis marker at a point of diagnosis in patients with chronic liver disease. However, their applicability for the monitoring of progression of liver fibrosis over time is yet to be determined. We aimed to clarify the feasibility of APRI and FIB-4 for the longitudinal evaluation of liver fibrosis in patients with chronic hepatitis B and C.

Methods

This is a multi-center retrospective and prospective cohort study, enrolling 1029 patients with HCV and 384 patients with HBV who were histologically diagnosed by liver biopsy. The observation period of retrospective and prospective study was 14 and 12 years, respectively. The APRI and FIB-4 were traced back in cases of histologically diagnosed cirrhosis, and those were prospectively analyzed after biopsy in cases diagnosed as F3 of METAVIR score, respectively.

Results

The averaged APRI and FIB-4 exhibited time-dependent increase in the retrospective study of hepatitis C patients (increase by 0.09/year in APRI and 0.29/year in FIB-4). In the prospective study of untreated hepatitis C patients, such increases were 0.14/year in APRI and 0.40/year in FIB-4, respectively. Neither the average of APRI nor FIB-4 showed a specific tendency with hepatitis B patients and treatment-experienced hepatitis C patients.

Conclusion

The APRI and FIB-4 may serve as a transition indicator of liver fibrosis in anti-viral treatment-naïve patients with chronic hepatitis C.

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Abbreviations

APRI:

AST to platelet ratio index

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

ROC analysis:

Receiver operating characteristic analysis

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Acknowledgements

We are grateful to the doctors in the following institutes for their support during this study: the Hospital of Hyogo College of Medicine, Hiroshima University Hospital, Hokkaido University Hospital, Yamagata University Hospital, University of Yamanashi Hospital, Osaka City University Hospital, Kumamoto University Hospital, and Kurume University Hospital.

Funding

This work was supported by the Japan Agency for Medical Research and Development. This study was conducted as a part of the Policy Research for Hepatitis Measures of the Ministry of Health, Labor and Welfare in Japan and was supported by Health, Labour and Welfare Sciences Research Grants in Japan (Grant number H29- kansei-shitei-001 and 20HC2002).

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan

    Jun Itakura, Masayuki Kurosaki & Namiki Izumi

  2. Department of Gastroenterology and Hepatology, Kumamoto Rosai Hospital, Yatsushiro, Japan

    Hiroko Setoyama

  3. Department of Gastroenterology, Saga Medical Center Kouseikan, Saga, Japan

    Tetsuro Simakami & Shuichi Kaneko

  4. Department of Molecular Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Japan

    Noriko Oza

  5. Department of Liver Disease, Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, Tokyo, 272-8516, Japan

    Masaaki Korenaga & Tatsuya Kanto

  6. Department of Gastroenterology and Hepatology, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan

    Motohiko Tanaka

  7. Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan

    Takuji Torimura

  8. Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Naoya Sakamoto

  9. First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan

    Nobuyuki Enomoto

  10. Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan

    Yoshiyuki Ueno

  11. Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan

    Norifumi Kawada

  12. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo College of Medicine, Nishinomiya, Japan

    Shuhei Nishiguchi

  13. Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Kazuaki Chayama

  14. Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Junko Tanaka

Authors
  1. Jun Itakura
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  2. Masayuki Kurosaki
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  4. Tetsuro Simakami
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  17. Namiki Izumi
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  18. Tatsuya Kanto
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Contributions

Conceptualization: JI, MK and TK. Methodology: JI, MK and TK. Formal analysis: JI. Investigation: JI, HS, NO and MK. Resources: JI, HS, TS, NO, MK, MT, TT, NS, NE, YU, NK, SK, SN, KC, and JT. Data curation: JI, HS. Writing (original draft preparation): JI. Writing (review and editing): MK and TK. Supervision: MK and TK. Project administration: TK. Funding acquisition: TK.

Corresponding author

Correspondence to Tatsuya Kanto.

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Itakura, J., Kurosaki, M., Setoyama, H. et al. Applicability of APRI and FIB-4 as a transition indicator of liver fibrosis in patients with chronic viral hepatitis. J Gastroenterol 56, 470–478 (2021). https://doi.org/10.1007/s00535-021-01782-3

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  • DOI: https://doi.org/10.1007/s00535-021-01782-3

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