Comparison of noninvasive serum markers with transient elastography for assessment of liver fibrosis in hepatitis B and C patients

Objectives: The study aimed to evaluate the accuracy of the aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4) scores in identifying liver fibrosis by comparing their diagnostic performance with transient elastography (FibroScan) in patients with chronic hepatitis B (HBV) and hepatitis C (HCV). Materials and Methods: An observational cohort study was conducted in the Department of Medicine at a tertiary care hospital in Haryana, India. Adults (≥18 years) with confirmed HBV or HCV infection were enrolled after serological confirmation and viral deoxyribonucleic acid/ribonucleic acid quantification. APRI and FIB-4 scores were calculated using biochemical and hematologic parameters, with cutoff values of ≥2 and ≥3.25, respectively, indicating advanced fibrosis. Fibrosis staging was performed using FibroScan elastography based on the METAVIR scoring system. Data were analyzed using Statistical Package for the Social Sciences version 25, and a P value ≤ 0.05 was considered statistically significant. Results: A total of 151 patients (mean age, 43.93 ± 13.57 years; 70.2% male) were analyzed. The mean liver stiffness was 10.84 ± 4.69 kPa. Both APRI and FIB-4 values increased progressively with advancing fibrosis ( P = 0.001). Receiver operating characteristic analysis revealed an area under the curve of 0.908 ( P < 0.001) for APRI and 0.838 ( P < 0.001) for FIB-4. At optimized thresholds, APRI (cutoff = 0.7) demonstrated a sensitivity of 73.6% and a specificity of 87.6%, whereas FIB-4 (cutoff = 1.65) showed a sensitivity of 81.6% and a specificity of 88.7%. Both markers exhibited high negative predictive values (>93%). Conclusion: APRI and FIB-4 are reliable, inexpensive, noninvasive tools strongly correlating with FibroScan for the evaluation of liver fibrosis in patients with chronic HBV and HCV. APRI shows higher diagnostic accuracy, while FIB-4 shows greater sensitivity, making them especially valuable in resource-limited settings lacking elastography access.