Published online May 18, 2016. doi: 10.4254/wjh.v8.i14.616
Peer-review started: January 8, 2016
First decision: February 26, 2016
Revised: March 8, 2016
Accepted: April 20, 2016
Article in press: April 22, 2016
Published online: May 18, 2016
AIM: To investigate the combined diagnostic accuracy of acoustic radiation force impulse (ARFI), aspartate aminotransferase to platelet ratio index (APRI) and Forns index for a non-invasive assessment of liver fibrosis in patients with chronic hepatitis B (CHB).
METHODS: In this prospective study, 206 patients had CHB with liver fibrosis stages F0-F4 classified by METAVIR and 40 were healthy volunteers were measured by ARFI, APRI and Forns index separately or combined as indicated.
RESULTS: ARFI, APRI or Forns index demonstrated a significant correlation with the histological stage (all P < 0.001). According to the AUROC of ARFI and APRI for evaluating fibrotic stages more than F2, ARFI showed an enhanced diagnostic accuracy than APRI (P < 0.05). The combined measurement of ARFI and APRI exhibited better accuracy than ARFI alone when evaluating ≥ F2 fibrotic stage (Z = 2.77, P = 0.006). Combination of ARFI, APRI and Forns index did not obviously improve the diagnostic accuracy compared to the combination of ARFI and APRI (Z = 0.958, P = 0.338).
CONCLUSION: ARFI + APRI showed enhanced diagnostic accuracy than ARFI or APRI alone for significant liver fibrosis and ARFI + APRI + Forns index shows the same effect with ARFI + APRI.
Core tip: Chronic hepatitis B (CHB) is a major health problem in a lot of countries all over the world, particularly in China. An accurate staging of liver fibrosis is critical for prognosticating this disease. However, although it is still the golden standard, liver biopsy is hindered by its inherent drawbacks in clinical applications. In this study, we demonstrated that non-invasive methods, including acoustic radiation force impulse (ARFI), aspartate aminotransferase to platelet ratio index (APRI) and Forns index showed significant correlations with the histological staging results from liver biopsy. The combined measurement of ARFI and APRI had the best diagnostic accuracy, which provided an ideal and convenient non-invasive diagnostic method for the detection of hepatic fibrosis of CHB patients in clinical practice.