1Department of Liver Surgery & State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
The aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the four factors (FIB-4) are the two most widely studied non-invasive tools for assessing liver fibrosis. Our objectives were to systematically review the performance of APRI and FIB-4 in hepatitis B virus (HBV) infection in adult patients and compare their advantages and disadvantages. We examined the diagnostic accuracy of APRI and FIB-4 for significant fibrosis, advanced fibrosis and cirrhosis based on their sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver-operating characteristic curve (AUC). Heterogeneity was explored using meta-regression. Our systemic review and meta-analysis included 16 articles of APRI only, 21 articles of APRI & FIB-4 and 2 articles of FIB-4 for detecting different levels of liver fibrosis. With an APRI threshold of 0.5, 1.0 and 1.5, the sensitivity & specificity values were 70.0% & 60.0%, 50.0% & 83.0% and 36.9% & 92.5% for significant fibrosis, advanced fibrosis and cirrhosis, respectively. With an FIB-4 threshold of 1.45 and 3.25, the sensitivity & specificity values were 65.4% & 73.6% and 16.2% & 95.2% for significant fibrosis. The summary AUC values using APRI & FIB-4 for the diagnosis of significant fibrosis, advanced fibrosis and cirrhosis were 0.7407 (95% CI: 0.7033-0.7781) & 0.7844 (95% CI: 0.7450-0.8238) (Z=1.59, P=0.06), 0.7347 (95% CI: 0.6790-0.7904) & 0.8165 (95% CI: 0.7707-0.8623) (Z=2.01, P=0.02) and 0.7268 (95% CI: 0.6578-0.7958) & 0.8448 (95% CI: 0.7742-0.9154) (Z=2.34, P=0.01), respectively. Conclusions: Our meta-analysis suggests that APRI and FIB-4 can identify hepatitis B-related fibrosis with a moderate sensitivity and accuracy.