Sarkari Madhavi, Chaudhary Smita, Gautam Bechan Kumar
Department of Medicine, Baba Raghav Das Medical College, Gorakhpur, Gorakhpur, IND.
Cureus. 2024 Nov 29;16(11):e74728. doi: 10.7759/cureus.74728. eCollection 2024 Nov.
This study aimed to evaluate the severity of liver fibrosis in chronic liver disease patients using aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 (FIB-4), FibroScan, and the Child-Turcotte-Pugh (CTP) score. It emphasized assessing fibrosis progression toward cirrhosis (F4 stage) and exploring the correlation between non-invasive markers and the CTP score for liver function and prognosis.
This observational cross-sectional study was conducted over one calendar year in the Department of Medicine at Baba Raghav Das (BRD) Medical College, Gorakhpur, India. A total of 200 patients with chronic liver disease were selected. Fibrosis scores were calculated using FibroScan, APRI, and FIB-4, while the modified CTP score was determined for each participant. Pearson's correlation was used to assess relationships between variables, while logistic regression evaluated the association of non-invasive methods (APRI, FIB-4, FibroScan) with severe fibrosis (F4). Odds ratios (ORs), sensitivity, specificity, and AUC were calculated, and ROC curves visualized their discriminative ability. Statistical significance was defined as p < 0.05.
The study revealed a predominance of advanced fibrosis (F4) in males (82.5%) and patients with ethanol-induced liver disease (84.6%). FIB-4 had the strongest predictive value for advanced fibrosis with an OR of 3.8 (95% CI: 3.0-4.5) and AUC of 0.743, followed by APRI with an OR of 2.5 (95% CI: 1.9-3.1) and AUC of 0.757. CTP showed the highest sensitivity (95.45%) but a lower AUC (0.697), indicating its clinical value in correlating fibrosis severity with liver dysfunction. Hemoglobin, platelets, and INR showed no significant correlation with fibrosis, while total bilirubin was elevated in advanced CTP classes. A moderate positive correlation (r = 0.481, p < 0.001) was observed between fibrosis scores and CTP, linking fibrosis severity with liver dysfunction. These findings emphasize FIB-4's superior predictive accuracy, while APRI and CTP remain valuable complementary tools for liver disease prognosis.
In conclusion, FIB-4 is the most accurate for staging advanced fibrosis, while APRI excels in initial screening due to its higher sensitivity. FibroScan effectively assesses direct fibrosis, and the CTP score adds prognostic value, making these methods complementary for managing chronic liver diseases.
本研究旨在使用天冬氨酸转氨酶与血小板比值指数（APRI）、纤维化-4（FIB-4）、FibroScan和Child-Turcotte-Pugh（CTP）评分评估慢性肝病患者肝纤维化的严重程度。重点评估纤维化向肝硬化（F4期）的进展情况，并探讨非侵入性标志物与肝功能及预后的CTP评分之间的相关性。
本观察性横断面研究在印度戈勒克布尔巴巴拉格哈夫达斯（BRD）医学院内科进行，为期一个日历年。共选取200例慢性肝病患者。使用FibroScan、APRI和FIB-4计算纤维化评分，同时为每位参与者确定改良的CTP评分。采用Pearson相关性分析评估变量之间的关系，使用逻辑回归评估非侵入性方法（APRI、FIB-4、FibroScan）与严重纤维化（F4）的关联。计算比值比（OR）、敏感性、特异性和AUC，并绘制ROC曲线以显示其判别能力。统计学显著性定义为p<0.05。
研究显示，男性（82.5%）和酒精性肝病患者（84.6%）中晚期纤维化（F4）占主导。FIB-4对晚期纤维化的预测价值最强，OR为3.8（95%CI：3.0 - 4.5），AUC为0.743，其次是APRI，OR为2.5（95%CI：1.9 - 3.1），AUC为0.757。CTP显示出最高的敏感性（95.45%），但AUC较低（0.697），表明其在将纤维化严重程度与肝功能障碍相关联方面的临床价值。血红蛋白、血小板和国际标准化比值（INR）与纤维化无显著相关性，而晚期CTP分级中总胆红素升高。纤维化评分与CTP之间存在中度正相关（r = 0.481，p < 0.001），将纤维化严重程度与肝功能障碍联系起来。这些发现强调了FIB-4卓越的预测准确性，而APRI和CTP仍然是肝病预后有价值的补充工具。
总之，FIB-4在晚期纤维化分期方面最为准确，而APRI因其较高的敏感性在初始筛查方面表现出色。FibroScan能有效评估直接纤维化，CTP评分增加了预后价值，这些方法在慢性肝病管理中相互补充。
