Introduction
Assessment of liver fibrosis is a key element in the management of patients with hepatitis B virus (HBV) infection, whether in the active, inactive, or occult phase. Among the non-invasive tools currently available, the FIB-4 score, based on biological parameters and FibroScan, using vibration-controlled transient elastography (VCTE) are widely used.
Aims & Methods
This retrospective, descriptive, and analytical study was conducted in a university hospital between 2017 and 2025. All patients followed for chronic HBV infection in the department of hepatogastroenterology were included. Clinical and biological data, along with fibrosis assessment results (FIB-4 score and FibroScan), were collected from patients medical records. The aim of this study was to compare the diagnostic performance and concordance of these two modalities in assessing liver fibrosis in a heterogeneous population of HBV-infected patients.
Results
A total of 100 HBV-infected patients were included, consisting of 54 males (54%) and 46 females (46%), with a median age of 55 years [42.5; 60]. Among them, 70% of patients had an active chronic hepatitis B (n=70), 29% were in the inactive phase (n=29), and 1 patient had an occult HBV infection.
Regarding comorbidities, 14% had arterial hypertension, 13% had metabolic dysfunction-associated steatotic liver disease (MASLD), and 5% had type 2 diabetes mellitus. Alcohol consumption was reported in 4% (n=4), and 5% were smokers (n=5). A family history of liver disease was documented in 12% of cases (n=12).
Concerning virological parameters, HBe antigen was positive in 13% (n=13) and negative in 87% (n=87). HBV DNA levels were <2,000 IU/mL in 48% of patients (n=48), between 2,000 and 20,000 IU/mL in 25% (n=25), and >20,000 IU/mL in 27% (n=27).
Evaluation of liver fibrosis using both the FIB-4 score and FibroScan revealed that 40% of patients had a FIB-4 score >3.25, indicating advanced fibrosis, while 60% had a score <1.45, suggesting minimal fibrosis. These findings were consistent with those obtained by FibroScan. To assess the diagnostic performance of the FIB-4 score in detecting advanced fibrosis (F3–F4) according to FibroScan, a receiver operating characteristic (ROC) analysis was conducted. The FIB-4 score demonstrated an area under the curve (AUC) of 0.96 using a cutoff value of 1.96, with a sensitivity of 93.75%, specificity of 84.52%, and a negative predictive value (NPV) of 98.61%.
Conclusion
The FIB-4 score demonstrated excellent diagnostic accuracy for identifying advanced liver fibrosis in patients with HBV infection, with a performance comparable to that of FibroScan. Given its simplicity, accessibility, and cost-effectiveness, the FIB-4 index represents a reliable first-line tool for fibrosis screening, particularly in settings where elastography is unavailable or limited.
