APRI and FIB-4 in the evaluation of liver fibrosis in chronic hepatitis C patients stratified by AST level

Background and aim The aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4) are commonly used compound surrogates for advanced fibrosis in chronic hepatitis C (CHC) patients. However, the use of APRI and FIB-4 entails a risk of overestimating the fibrosis stage due to the impact of necroinflammatory activity on transaminases. We sought to investigate the optimal cutoff values of the two compound surrogates for predicting cirrhosis stratified by AST level. Methods This retrospective study enrolled 1716 treatment-naive CHC patients who underwent liver biopsy prior to interferon therapy from 1997–2010. Fibrosis was scored according to the modified Knodell classification. The upper limit for normal AST in our hospital is 37 IU/L. We stratified the enrolled patients into the categories of AST37 IU/L (N = 132), 37<AST74, (N = 501), 74<AST148 IU/L (N = 737), and AST>148 IU/L (N = 346). Results 436 patients had cirrhosis (F4). The area under receiver operating characteristic (AUROC) analysis results distinguishing cirrhosis (F4) from non-cirrhosis (F0–F3) were 0.81 for APRI and 0.85 for FIB-4 in patients with AST37 IU/L; 0.71 for APRI and 0.72 for FIB-4 in patients with 37<AST74IU/L; 0.72 for APRI and 0.73 for FIB-4 in patients with 74<AST148 IU/L; and 0.68 for APRI and 0.70 for FIB-4 in patients with AST>148 IU/L. The optimal cutoff values of APRI and FIB-4 for the diagnosis of cirrhosis were 0.6 and 1.4, respectively, in patients with AST37 IU/L; 1.1 and 2.2, respectively, in patients with 37<AST74 IU/L; 2.2 and 3.4, respectively, in patients with 74<AST148 IU/L; and 3.4 and 5.5, respectively, in patients with AST>148 IU/L. Conclusions We provide optimal cutoff values of both APRI and FIB-4 to predict cirrhosis stratified by AST levels, which should be more feasible compared with the single cutoff values proposed in previous studies.