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Validation of FIB-4 and comparison with other simple noninvasive indices for predicting liver fibrosis and cirrhosis in hepatitis B virus-infected patients

 Beom Kyung Kim  ;  Do Young Kim  ;  Jun Yong Park  ;  Sang Hoon Ahn  ;  Chae Yoon Chon  ;  Ja Kyung Kim  ;  Yong Han Paik  ;  Kwan Sik Lee  ;  Young Nyun Park  ;  Kwang Hyub Han 
 LIVER INTERNATIONAL, Vol.30(4) : 546-553, 2010 
Journal Title
Issue Date
Adult ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Biomarkers/blood* ; Biopsy, Needle ; Cohort Studies ; Diagnosis, Differential ; Disease Progression ; Female ; Hepatitis B, Chronic/diagnosis ; Hepatitis B, Chronic/pathology* ; Humans ; Immunohistochemistry ; Liver Cirrhosis/diagnosis ; Liver Cirrhosis/pathology* ; Liver Cirrhosis/virology ; Male ; Platelet Count ; Predictive Value of Tests ; RNA, Viral/blood ; ROC Curve ; Reproducibility of Results ; Severity of Illness Index ; Viral Load
chronic hepatitis B ; cirrhosis ; FIB‐4 index ; liver biopsy ; prediction
BACKGROUNDS: To optimize management and predict long-term clinical courses in patients with chronic hepatitis B (CHB), noninvasive tests to determine the degree of hepatic fibrosis have been developed.

AIMS: This study aimed to validate a simple, noninvasive FIB-4 index, which was first derived from an HCV-HIV-co-infected population, in patients with CHB and to compare it with other noninvasive tests for predicting cirrhosis.

METHODS: From 2006-2008, a total of 668 consecutive CHB patients who underwent liver biopsies were enrolled. The fibrosis stage was assessed according to the Batts and Ludwig system by a single pathologist blinded to patients' data.

RESULTS: For prediction of significant (F > or = 2) and severe (F > or = 3) fibrosis, and cirrhosis (F = 4), the area under the receiver-operating characteristic curves were 0.865, 0.910 and 0.926 respectively. In predicting cirrhosis, it demonstrated diagnostic values comparable to the age-spleen platelet ratio index (0.937, P=0.414) and age-platelet index (0.928, P=0.888), and better outcomes than spleen-platelet ratio index (0.882, P=0.007), aspartate aminotransferase (AST)-platelet ratio index (0.731, P<0.001) and AST-alanine aminotransferase ratio index (0.730, P<0.001). FIB-4 cut-offs of 1.6 and 3.6 provided 93.2% negative predictive value and 90.8% positive predictive value for detection of cirrhosis respectively. Based on these results, liver biopsy could be avoided in 70.5% of the study population. These cut-offs were validated internally using bootstrap resampling methods, showing good agreement.

CONCLUSIONS: FIB-4 is a simple, accurate and inexpensive method of predicting cirrhosis, with outcomes comparable to other noninvasive tests and may reduce the need for liver biopsy in the majority of CHB patients
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Ja Kyung(김자경) ORCID logo https://orcid.org/0000-0001-5025-6846
Park, Young Nyun(박영년) ORCID logo https://orcid.org/0000-0003-0357-7967
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Paik, Yong Han(백용한)
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Lee, Kwan Sik(이관식) ORCID logo https://orcid.org/0000-0002-3672-1198
Chon, Chae Yoon(전재윤)
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
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