Does Helicobacter pylori infection affect indirect hepatic fibrosis tests?

Early detection, accurate evaluation, and proper follow-up of fibrosis in chronic liver disease are crucial for improving disease prognosis. Indirect biochemical fibrosis tests, such as the AST-to-Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) score, have been developed, incorporating parameters like AST, ALT, and platelet count. However, the influence of factors such as Helicobacter pylori (H. pylori) on fibrosis tests such as APRI and FIB-4 remains unclear, and this study aimed to evaluate its impact.

This study included 190 patients (aged ≥18 years) who underwent gastric and liver biopsies at a tertiary center between 2006 and 2021. Patients were categorized into three groups based on liver histopathological findings: mild (F0-1), moderate (F2-3), and advanced (F4-6) fibrosis. Additionally, patients were grouped based on H. pylori presence as determined by gastric histopathology. Demographic, clinical, laboratory, imaging, and histopathological characteristics were analyzed and compared between groups.

Among the 190 patients, H. pylori was detected in 135 (71%) and was absent in 55 (29%). No significant differences were observed between H. pylori-positive and -negative groups in terms of AST, ALT, platelet count, INR, FIB-4, or APRI scores. For APRI, significant differences were found between mild-moderate and mild-advanced fibrosis groups (p<0.001), but not between moderate and advanced groups (p>0.05). For FIB-4, significant differences were observed across all fibrosis groups (p<0.001). The presence of H. pylori did not significantly affect the APRI or FIB-4 scores within any fibrosis group.

The presence of H. pylori did not significantly impact APRI or FIB-4 scores. These indices can reliably assess liver fibrosis, regardless of H. pylori status.