The diagnostic performance of non-invasive fibrosis markers for predicting fibrosis in primary biliary cholangitis patients

Year 2024, Volume: 15 Issue: 4, 642 - 649, 31.12.2024

Nermin Mutlu Bilgiç , Gupse Adalı

https://doi.org/10.18663/tjcl.1594235

Abstract

Aim: This study aimed to investigate the relationship between liver fibrosis measured by transient elastography and non-invasive fibrosis scoring systems, including Fibrosis-4 (FIB-4) and aspartate-aminotransferase (AST)-to-platelet ratio index (APRI), in patients with primary biliary cholangitis (PBC).
Material and Methods: A total of 45 PBC patients followed in the Gastroenterology Clinic were included in this retrospective study. Transient elastography was performed on all participants, and liver stiffness measurement (LSM) values were recorded in kilopascals (kPa). Fibrosis was defined as LSM ≥ 6.3 kPa, while advanced fibrosis was defined as LSM ≥ 10.5 kPa. To calculate the APRI score, the formula [(AST / upper normal limit × 100) / platelet count] was used, and for the FIB-4 score, the formula [(age × AST) / (platelet count × √alanine aminotransferase)] was applied.
Results: Liver fibrosis was identified in 71.1% (n = 32) of patients, with advanced fibrosis present in 40.0% (n = 18). Patients with fibrosis had higher APRI and FIB-4 scores compared to those without fibrosis. Also, the median APRI score (0.7 vs. 0.5, p < 0.001) and median FIB-4 score (2.4 vs. 1.6, p < 0.001) were higher in patients with advanced liver fibrosis than in those without. For detecting fibrosis, the AUROC values were 0.73 (95% CI: 0.58–0.89) for APRI and 0.84 (95% CI: 0.73–0.96) for FIB-4. FIB-4 also showed higher accuracy than APRI for identifying advanced fibrosis (AUROC: 0.78 vs. 0.70, p = 0.042).
Conclusion: Both APRI and FIB-4 are useful non-invasive tools for detecting and staging fibrosis in PBC. However, FIB-4 demonstrated superior diagnostic performance compared to APRI, particularly in predicting advanced fibrosis. Incorporating these markers into routine clinical practice may reduce the need for invasive liver biopsy and help optimize patient management.

Keywords

Primary biliary cholangitis, transient elastography, liver fibrosis, FIB-4 score, APRI score

Primer biliyer kolanjit hastalarında fibrozisi öngörmede invaziv olmayan fibrozis belirteçlerinin tanısal performansı

Abstract

Amaç: Bu çalışma, primer biliyer kolanjit (PBC) hastalarında transient elastografi ile ölçülen karaciğer fibrozisi ile Fibrozis-4 (FIB-4) ve aspartat-aminotransferaz-trombosit oranı indeksi (APRI) gibi non-invaziv fibrozis skorlama sistemleri arasındaki ilişkiyi araştırmayı amaçladı.
Gereç ve Yöntemler: Gastroenteroloji Kliniği’nde takip edilen toplam 45 PBC hastası bu retrospektif çalışmaya dahil edildi. Tüm katılımcılara transient elastografi uygulandı ve karaciğer sertliği ölçüm (LSM) değerleri kilopaskal (kPa) cinsinden kaydedildi. Fibrozis, LSM ≥ 6.3 kPa olarak tanımlanırken, ileri fibrozis LSM ≥ 10.5 kPa olarak kabul edildi. APRI skorunun hesaplanmasında [(AST / üst normal sınır × 100) / trombosit sayısı] formülü, FIB-4 skorunun hesaplanmasında ise [(yaş × AST) / (trombosit sayısı × √alanin aminotransferaz)] formülü uygulandı.
Bulgular: Hastaların %71.1’inde (n = 32) karaciğer fibrozisi, %40.0’ında (n = 18) ise ileri fibrozis saptandı. Fibrozisi olan hastalarda ibrozisi olmayan hastalara kıyasla APRI ve FIB-4 skorları f daha yüksekti. İleri fibrozisi olan hastalarda ileri fibrozis olmayan hastalara kıyasla da APRI (0.7 vs. 0.5, p < 0.001) ve FIB-4 (2.4 vs. 1.6, p < 0.001) skorları daha yüksekti. Fibrozisin saptanmasında, AUROC değerleri APRI için 0.73 (%95 GA: 0.58–0.89) ve FIB-4 için 0.84 (%95 GA: 0.73–0.96) olarak bulundu. FIB-4, ileri fibrozisi belirlemede de APRI’ye göre daha yüksek doğruluk gösterdi (AUROC: 0.78 karşı 0.70, p = 0.042).
Sonuç: APRI ve FIB-4, PBC hastalarında fibrozis tespiti ve evrelemesi için kullanışlı non-invaziv araçlardır. Bununla birlikte, FIB-4 özellikle ileri fibrozisi öngörmede APRI’ye kıyasla üstün tanısal performans sergilemiştir. Bu belirteçlerin rutin klinik uygulamalara dahil edilmesi, invaziv karaciğer biyopsisi ihtiyacını azaltabilir ve hasta yönetimini optimize etmeye yardımcı olabilir.

Keywords

Primer biliyer kolanjit, transient elastografi, karaciğer fibrozisi, FIB-4 skoru, APRI skoru

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