COMPARISON BETWEEN FIB-4 INDEX AND APRI INDEX FOR PREDICTING THE SEVERITY OF LIVER DISEASE IN THE PATIENTS OF CHRONIC HEPATITIS C: ARETROSPECTIVE SINGLE-CENTRE STUDY

Abstract

Hepatitis C virus (HCV) is a significant cause of chronic liver disease which may progress to liver fibrosis, liver cirrhosis and hepato-cellular carcinoma. According to the Pakistan Medical Association, the current prevalence of HCV in Pakistan is 7.5%, the  highest recorded globally, equating to an estimated 9.8 million individuals living with the  infection. In response to the global burden, the World Health Organization has set an ambitious target to eliminate hepatitis as a public health threat by the year 2030. This goal underscores the urgent need for accessible, cost-effective and non-invasive methods to assess the severity of liver disease in patients with HCV, particularly in rural and resource limited settings. Liver biopsy, though regarded as the gold standard, is invasive, necessitating specialized equipment and clinical expertise. Similarly, non-invasive modalities such as transient elastography and advanced imaging techniques remain expensive and operator dependent. The present study aimed to compare the diagnostic performance of the FIB-4 and APRI indices in predicting the severity of hepatic fibrosis or cirrhosis. A total of 159 medical records of patients diagnosed with HCV-related liver fibrosis were retrospectively analyzed. All patients underwent clinical examination, alongside laboratory investigations including complete blood count, liver function tests, serum albumin, prothrombin time, and abdominal ultrasonography. FIB-4 and APRI scores were subsequently calculated for each individual. Of the 159 patients, 39(24.53%) were found to have F4 fibrosis, while 120 (75.47%) had fibrosis graded between F0 and F3. Notably, patients with F4 fibrosis exhibited elevated FIB-4 scores (mean4.84±4.14) and APRI scores (mean 2.06 ± 3.22) compared to those with milder disease. Receiver operating characteristic (ROC) curve analysis demonstrated that the area under the curve (AUC) for the FIB-4 index was 0.855, compared to 0.767 for the APRI score. These results suggest that FIB-4 demonstrates marginally superior accuracy in identifying patients with advanced fibrosis or cirrhosis secondary to HCV infection.