COMPARISON OF APRI AND FIB-4 INDICES WITH ELASTOGRAPHY FOR NON INVASIVE ASSESSMENT OF LIVER INJURY IN CHRONIC HEPATITIS B: A COMPARATIVE RETROSPECTIVE STUDY IN A TERTIARY HEALTHCARE SETUP IN SOUTHERN ASSAM

Background: Chronic hepatitis B is a global health problem with risk of progression to liver fibrosis, cirrhosis and hepatocellular carcinoma. Liver biopsy is the gold standard for the detection of liver fibrosis, but has limitations such as invasive procedure, high cost, risk of rare but potentially life-threatening complications. Non-invasive indices like aspartate transaminase to platelet ratio index (APRI) and fibrosis 4 (FIB-4) are increasingly used for identifying liver fibrosis and cirrhosis in patients with chronic hepatitis B virus (HBV)infection.

Objectives: To evaluate and compare the diagnostic performance of APRI and FIB 4 indices with elastography in assessment of liver fibrosis in patients with chronic hepatitis B(CHB).

Materials and methods: We conducted a comparative retrospective study on 87 patients with chronic hepatitis B at a tertiary care center in southern Assam.

Result and observation: In the present study, 87 patients were evaluated, with a predominance of males and a mean age of 40.72±13.73 years. Most patients had early stages of fibrosis on elastography, although nearly one third had significant fibrosis(>=F2). A significant association was observed between fibrosis stage and elastography categories (p=0.0001), confirming the reliability of elastography in staging liver fibrosis. Both APRI and FIB 4 showed a significant positive correlation with liver stiffness values (APRI r=0.311, p=0.003, FIB4r =0.307, p=0.004). ANOVA analysis also demonstrated significant differences in APRI and FIB-4 levels across fibrosis stages. ROC analysis showed moderate diagnostic performance of APRI and FIB -4 for detecting significant fibrosis, while both markers performed better in identifying advanced fibrosis. Agreement analysis revealed poor agreement between APRI and elastography, whereas FIB-4 showed fair agreement and a stronger association with elastography findings.

Conclusion: APRI and FIB 4 are useful noninvasive markers for assessment of liver fibrosis in chronic hepatitis B. Both scores correlate with elastography findings, but FIB 4 demonstrates better diagnostic performance and agreement with elastography making it a more reliable tool in clinical practice.