Comparison of APRI, FIB-4 and fibroscan for detecting chronic liver disease severity among chronic Hepatitis B Patients in Pakistan.

Objective: To compare aspartate aminotransferase to platelet ratio index (APRI), fibrosis-4 index (FIB-4), and fibroscan scores in evaluating severity of chronic liver disease (CLD) in chronic hepatitis B (CHB) patients. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital and Medical College, Karachi, Pakistan. Period: 11th July 2024 to 10th January 2025. Methods: A total of 250 patients aged 18 years or above, and presenting with CHB were analyzed. Necessary laboratory investigations and Fibroscan evaluation were performed for the assessment of APRI and FIB-4 scores and fibrosis confirmation. Predictive ability of all scores was determined by plotting receiver operating characteristic curve (ROC), and determining area under the curve (AUC). Youden index was applied for the calculation of the optimal cut-off value of the score. Results: Total 22.0% were female and 78.0% were male patients. Median (IQR) scores for APRI, FIB-4, and Fibroscan were 0.74 (0.35-2.20), 1.32 (0.90-2.90), and 9.10 (5.30-16.00). The AUC indicates that the APRI score (AUC=0.980) is a better predictor of CLD severity than the FIB-4 score (AUC=0.929). The optimal cutoff for APRI score was 0.789 (sensitivity=85.3%, specificity=100%), 0.662 (sensitivity=92.2%, specificity=92.6%), and 0.858 (sensitivity=78.3%, specificity=100%). Conclusion: In CHB patients, APRI seems an excellent tool for determining the severity of CLD and showed the highest association with FibroScan results.