Background: Liver biopsy-the gold standard in assessing liver histology-is recommended before all antiviral treatment. However, this procedure may cause complications, is costly, and is limited by sampling errors. Hence, noninvasive tests have been proposed to assess the severity of hepatic fibrosis. We propose a novel noninvasive index for predicting liver fibrosis, named fibro-quotient (FibroQ), and compared the diagnostic accuracies of FibroQ, aspartate aminotransferase (AST)-to-platelet ratio index (APRI), and AST/alanine aminotransferase (ALT) ratio (AAR).
Methods: This retrospective cohort study included 140 consecutive patients with chronic viral hepatitis who had undergone percutaneous liver biopsy before treatment at the Chang Gung Memorial Hospital, Chiayi from May 2005 through December 2007. The clinical data including sex, age, AST, ALT, platelet count, prothrombin time (PT) international normalized ratio (INR), and the Metavir fibrosis score (F0 to F4) of liver histology were recorded. APRI, AAR, and FibroQ were calculated. Receiver operating characteristic (ROC) curves were constructed to compare the accuracies of these three noninvasive tests in predicting significant fibrosis in patients with chronic viral hepatitis.
Results: FibroQ performed better than APRI, but was equal to AAR, in the prediction of significant fibrosis [area under the receiver operating characteristic curve (AUC): 0.783 vs 0.631 (p = 0.02) and 0.783 vs 0.733 (p = 0.26), respectively] and cirrhosis (AUC: 0.791 vs 0.634 (p = 0.03), and 0.791 vs 0.782 (p= 0.47), respectively). Using FibroQ below the lower cutoff value (0.6) and above the higher cutoff value (1.6), 108 of 140 (77.1%) patients could be identified correctly to have or not have significant fibrosis.
Conclusion: FibroQ, a novel noninvasive test, is an useful and easy tool to evaluate liver fibrosis in patients with chronic viral hepatitis and has better accuracy than APRI and is equal to AAR. Further prospective studies are warranted to validate its efficacy.