Stepwise Application of FIB-4, Red cell distribution width-Platelet Ratio and APRI for Compensated Hepatitis B Fibrosis Detection

Aim FIB-4 and APRI were validated with unsatisfactory efficiency. Routine hematology in-dex red cell distribution width-platelet ratio (RPR) had been tried in Liver Fibrosis detection. This study tries to evaluate the stepwise application of FIB-4, RPR and APRI in detecting CHB fibrosis. Methods A total of 246 compensated CHB patients underwent liver biopsies, transient elas-tography and routine blood tests including complete blood count were included. Dual Cutoffs were determined to exclude or include cirrhosis diagnosis. Performance of stepwise combining routine biomarkers including RPR, FIB-4 and APRI were statistically analyzed. Results The Metavir F0, F1, F2, F3 and F4 was identified in 2.4%, 22.0%, 32.1%, 24.0% and 19.5% of the eligible patients, respectively. The area under receiver operating charac-teristics curves for detecting significant fibrosis and cirrhosis were 0.853, 0.883 for transient elastography, 0.719, 0.807 for FIB-4, 0.638, 0.791 for RPR, 0.720, 697 for APRI and 0.618, 0.760 for mean platelet volume-platelet ratio, respectively. The proportion of patient de-termined as cirrhosis or non-cirrhosis was 65.9% by transient elastography, 36.9% by FIB-4, 30.5% by RPR and 19.5% by APRI, respectively. These numbers for determining significant fibrosis were 49.6%, 24.2%, 21.5% and 23.6% in the same order. Detected by stepwise application of FIB-4, RPR and APRI, 41.5% and 52.8% of patients could be determined the state of significant fibrosis and cirrhosis, respectively. Conclusions In source-limited settings without transient elastography, stepwise applying FIB-4, RPR and APRI could free proportion of CHB patients from liver biopsies in detecting significant fibrosis and cirrhosis.