Introduction
Noninvasive assessment of liver fibrosis is essential in the management of chronic liver diseases. APRI and FIB-4 are simple, low-cost tools widely used for this purpose. This study aimed to evaluate the diagnostic performance of APRI and FIB-4 in identifying significant fibrosis (≥F2) and cirrhosis (F4), using transient elastography (FibroScan) as the reference standard, and to explore their clinical and biochemical correlations.
Aims & Methods
We conducted a cross-sectional study at the Institute of Gastroenterology and Hepatology, Iași, Romania, between January 1st, 2024 and April 1st, 2025. A total of 106 patients with chronic liver disease were included. Laboratory tests were used to calculate APRI and FIB-4 scores, and liver stiffness was measured by FibroScan. For diagnostic accuracy we performed ROC curve analysis and Pearson correlation coefficients were used to assess relationships between noninvasive scores and clinical-biological variables. Statistical analysis was performed using MedCalc® Statistical Software version 23.2.1 (MedCalc Software Ltd, Ostend, Belgium).
Results
For the detection of significant fibrosis (≥F2), the area under the ROC curve (AUC) was 0.748 for APRI (p < 0.001) and 0.752 for FIB-4 (p < 0.001). In diagnosing cirrhosis (F4 ≥12.5 kPa), FIB-4 demonstrated superior diagnostic accuracy (AUC 0.836, p < 0.001) compared to APRI (AUC 0.797, p < 0.001). A FIB-4 threshold of 1.45 provided a sensitivity of 68.6% and a specificity of 83.3% for detecting significant fibrosis. High cut-offs (≥2.0 for APRI and ≥4.0 for FIB-4) were associated with a specificity exceeding 96%. A significant positive correlation was observed between APRI and FIB-4 (r = 0.96, p < 0.001). Moreover, FIB-4 correlated moderately with FibroScan values (r = 0.514), while APRI showed a weaker correlation (r = 0.423).
Conclusion
The results of this study confirm that both APRI and FIB-4 are effective noninvasive tools for the staging of liver fibrosis, with FIB-4 demonstrating superior diagnostic accuracy, particularly for cirrhosis. The moderate correlation between FIB-4 and FibroScan (r = 0.514) supports its potential role as a reliable surrogate marker, especially in settings where access to elastography is limited, outperforming the weaker correlation of APRI (r = 0.423) that suggests a lower predictive power, aligning with findings from previous studies that emphasized FIB-4's stronger association with liver stiffness and histological fibrosis progression. The high specificity associated with elevated cut-off values enhances the clinical applicability of these scores for ruling in advanced fibrosis and cirrhosis, minimizing the need for unnecessary imaging or biopsies. Overall, integrating FIB-4 and APRI into routine clinical practice could improve early identification of at-risk patients, optimize resource allocation, and facilitate timely therapeutic interventions.
References
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2. Gür-Altunay D, Yürük-Atasoy P. How Successful Are APRI and FIB-4 Scores in Predicting Liver Fibrosis in Chronic Hepatitis B Patients? Infect Dis Clin Microbiol. 2023 Dec 29;5(4):332-340. doi: 10.36519/idcm.2023.276. PMID: 38633858; PMCID: PMC10986711.
3. Rungta S, Kumari S, Deep A, Verma K, Swaroop S. APRI and FIB-4 performance to assess liver fibrosis against predefined Fibroscan values in chronic hepatitis C virus infection. J Family Med Prim Care. 2021 Nov;10(11):4082-4088. doi: 10.4103/jfmpc.jfmpc_666_21. Epub 2021 Nov 29. PMID: 35136771; PMCID: PMC8797084.
