Liver Fibrosis Staging in Chronic Hepatitis C

Liver cirrhosis
Liver cirrhosis
Investigators assessed the diagnostic performance of AST to Platelet Ratio Index and Fibrosis-4 scores compared with transient elastography evaluation of liver stiffness to detect significant fibrosis or cirrhosis.

The diagnostic biochemical scoring systems AST to Platelet Ratio Index (APRI) and the Fibrosis-4 (FIB-4) calculator both performed well compared with the transient elastography measurement of liver stiffness (TE-LS) in predicting significant fibrosis, while FIB-4 performed well in predicting cirrhosis, according to study results published in the Annals of Gastroenterology.

Identifying patients with cirrhosis or advanced fibrosis is particularly important in chronic hepatitis C (CHC), as the choice of treatment regimen and the post-treatment prognosis depends on the stage of fibrosis. Although liver biopsy has long been considered the gold standard for the assessment of liver fibrosis, noninvasive methods for measuring LS such as TE or biochemical and scoring systems have replaced it. TE-LS is not widely available. However, APRI and FIB-4 scores have been found to be quite reliable and low-cost.

Researchers retrospectively enrolled 575 patients with CHC who underwent TE-LS and compared these values with APRI and FIB-4 scores. They found that the combination of APRI/FIB-4 scores, with cutoff thresholds of 0.64 and 1.46, respectively, could potentially be used to predict patients with significant fibrosis, whereas the use of a FIB-4 score threshold of 1.63 could predict patients with cirrhosis. In addition, APRI-FIB-4-COMBO score thresholds of 0.3 and 0.98, respectively, could potentially be used to define patients with low fibrosis.

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The investigators concluded, “We believe that these markers could significantly reduce the need for TE-LS in the pretreatment evaluation of patients with CHC. This would allow a more rapid treatment decision for patients with CHC, which is of special significance in the era of a worldwide HCV elimination plan.”


Papadopoulos N, Vasileiadi S, Papavdi M, et al. Liver fibrosis staging with combination of APRI and FIB-4 scoring systems in chronic hepatitis C as an alternative to transient elastography. Ann Gastroenterol. 2019;32:1-6.