Performance of APRI and FIB-4 Scores Compared to FibroScan: A Cross-Sectional Study in a Black Sub-Saharan African
Jean-Bonny Nsumbu1,2, Jean-Robert Makulo3, Trésor Mutombo Tshiswaka4
1Unit of Hepato-Gastroenterology, Department of Internal Medicine, University Hospital of Kinshasa, Kinshasa, Congo.
Background And Aim:
Several non-invasive tests are used to assess liver fibrosis and cirrhosis in patients with liver disease. However, most validation studies have not included populations in sub-Saharan Africa. This study aimed to evaluate the diagnostic performance of the APRI and FIB-4 scores in a Congolese cohort.
Patients And Methods:
A cohort of patients in Kinshasa underwent FibroScan and laboratory testing to calculate APRI and FIB-4 scores. Pearson correlation, sensitivity, specificity, and ROC curve analyses were used to evaluate the performance of these non-invasive scores against FibroScan. Cirrhosis was defined as liver stiffness ≥14 kPa by FibroScan. Thresholds for APRI and FIB-4 scores predicting cirrhosis were set at ≥ 1.5 and ≥ 2.67, respectively.
Results:
The study included 316 patients (mean ± SD age: 48.1 ± 14.1 years; 60.8% male; 10.1% with diabetes; 37.1% obese; 14.2% with hepatitis B; 6.7% with hepatitis C; 25.6% with a history of alcohol use). The Pearson correlation between APRI and FibroScan was r = 0.210 (p < 0.001), while the correlation between FIB-4 and FibroScan was better (r = 0.478, p < 0.001). In subgroup analyses, FIB-4 correlated with FibroScan only among patients with alcohol use or hepatitis B or C, APRI only correlated with FibroScan in alcohol dependent patients. The sensitivity and specificity of APRI were 29.7% and 97.9% respectively, compared to 60.0% and 93.3% for FibroScan. The areas under the ROC curve were 0.8462 for APRI and 0.8312 for FIB-4, with thresholds lower than those reported in the literature: 0.422 for APRI and 1.285 for FIB-4, but these varied according to the subgroup.
Conclusion:
APRI and FIB-4 scores demonstrate high specificity but low sensitivity for diagnosing cirrhosis in this population. Their diagnostic performance is notably better in patients with alcohol-related liver disease or viral hepatitis, but poor among those with diabetes or obesity.
