Accuracy of APRI and FIB-4 compared to Ultrasound for Assessing Cirrhosis in Chronic Hepatitis C Virus Infection in Pakchongnana Hospital

Abstract

Background: This study explores the use of non-invasive biomarkers-APRI and FIB-4 as alternatives to abdominal ultrasound for assessing liver fibrosis in patients with chronic hepatitis C infection. The objective is to facilitate timely antiviral treatment in community hospitals, particularly those lacking radiologist. By relying on routine laboratory parameters, APRI and FIB-4 can help identify patients without cirrhosis, enabling treatment initiation without the need for ultrasound confirmation. This approach may reduce delays in care, minimize patient travel and associated costs, and expand access to hepatitis C therapy in underserved regions.
Objective: To determine whether APRI and FIB-4 can reliably identify chronic hepatitis C patients without cirrhosis, enabling treatment initiation at community hospitals without radiologist support.
Methods: This cross-sectional study included patients with chronic hepatitis C infection. All patients underwent upper abdominal ultrasonography performed by radiologists. Ultrasonographic findings were compared with the aspartate aminotransferase-to-platelet ratio index (APRI) and the fibrosis-4 (FIB-4) score to assess the presence or absence of liver cirrhosis. Descriptive statistics were used to summarize patient characteristics and laboratory results. Categorical variables were analyzed using the Chi-square test to determine the association between ultrasonographic findings and APRI and FIB-4 classifications.
A p‑value of less than 0.01 was considered statistically significant.
Results: Among patients with chronic hepatitis C infection without cirrhosis, the mean APRI was less than 1.5 and the mean FIB-4 score was less than 3.25 in 256 and 245 cases, respectively (85.3% and 81.7%). In contrast, among patients with chronic hepatitis C infection with cirrhosis, the mean APRI was greater than 1.5 and the mean FIB-4 score was greater than 3.25 in 44 and 55 cases, respectively (14.7% and 18.3%). These differences were statistically significant (p < 0.01 and p < 0.001, respectively).
Conclusions: Chronic hepatitis C patients without liver cirrhosis demonstrated mean APRI values below 1.5 and mean FIB‑4 scores below 3.25, whereas those with liver cirrhosis showed mean APRI values above 1.5 and mean FIB‑4 scores above 3.25. These findings suggest that APRI and FIB‑4 scores may serve as alternative non‑invasive indicators in place of upper abdominal ultrasonography.