Are FIB-4, APRI and GPR Good Predictors for Liver Fibrosis in Hepatitis C Patients According to Virus Genotypes?

Elza Cristina Miranda da Cunha, Bruna Brandão Farias, Natalia Xavier Carvalho, Christian Loret de Mola, Lysandro Alsina Nader, Gabriele Ghisleni


Aim: The accurate staging of hepatic fibrosis becomes a clinical priority to better estimate the prognosis and guide management decisions for patients infected with hepatitis C virus (HCV). Noninvasive approaches based on routine and low cost tests to assess liver fibrosis have been used toward increase the possibility of clinical use in the daily practice; the aim of this study is evaluate the accuracy of these tests to predict advanced fibrosis in patients with HCV.

Material and Methods: This study is a convenience cohort where 94 HCV patients were followed-up by 12 weeks during the antiviral therapy. All patients underwent liver biopsy and through laboratory data, the values for noninvasive methods, APRI, FIB-4 and GPR, were calculated to assess the accuracy of the tests in relation to liver biopsy, also considering the viral genotypes.

Results: The concordance of APRI in relation to liver biopsy for advanced fibrosis was AUROC = 0.67 (CI 95% 0.55-0.79). The GPR method represent an AUROC = 0.59 (CI 95% 0.46-0.73) for advanced fibrosis, while FIB-4 represent an AUROC = 0.69 (CI 95% 0.58-0.80) for advanced fibrosis. No significant difference was found when compared the three tests used (p = 0.306). Moreover, when evaluated the tests in relation to the viral genotypes, we found only statistical difference for GPR (p = 0.006), with better accuracy for genotype 2-3.

Conclusion: We found association between viral genotypes and advanced fibrosis in the relationship of GPR; however, the results showed no good accuracy for all index evaluated in our population.


Hepatic fibrosis; Liver biopsy; Hepatitis C

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