To evaluate the performance of
aspartate transaminase-to-platelet ratio index (APRI) and
fibrosis index based on four factors (FIB-4) to predict significant
fibrosis and
cirrhosis in hepatitis B virus
e antigen (
HBeAg)-negative
chronic hepatitis B (CHB) patients with
alanine transaminase (ALT) ≤ twice the upper limit of normal (2 ULN).Histologic and laboratory data of 236
HBeAg-negative CHB patients with ALT ≤ 2 ULN were analyzed. Predicted
fibrosis stage, based on established scales and cut-offs for APRI and FIB-4, was compared with METAVIR scores obtained from liver biopsy.In this study, the areas under the receiver operating characteristic curves (AUROCs) of APRI were lower than that of FIB-4 (0.62 vs 0.69; P = 0.019) for diagnosing significant
fibrosis; however APRI and FIB-4 were comparable for diagnosing
cirrhosis (0.77 vs 0.81; P = 0.374). When the cut-off proposed by WHO HBV guideline for APRI (>2.0) was used, no cirrhotic patients were correctly predicted. For FIB-4, the WHO proposed cut-off of 3.25 correctly identified significant
fibrosis 83% of the time; but for APRI, the WHO proposed cut-off of 1.5 identified significant
fibrosis 56%. In ruling out significant
fibrosis, the WHO proposed APRI cut-off of 0.5 had a predictive value of 39%, and the FIB-4 cut-off of 1.45 correctly identified lack of significant
fibrosis in 47% of the patients. In this study, based on ROC analysis, the optimal cut-offs were 0.46 and 0.65 for APRI, and 1.05 and 1.29 for FIB-4, for diagnosing significant
fibrosis and
cirrhosis, respectively. When the new cut-off of APRI (>0.65) was used, 82% of the cirrhotic patients were correctly predicted. In ruling out significant
fibrosis, the new APRI cut-off (<0.46) had a predictive value of 80%, and new FIB-4 cut-off (<1.05) correctly identified lack of significant
fibrosis in 84% of the patients.The WHO guidelines proposed cut-offs might be higher for
HBeAg-negative CHB patients with ALT ≤2 ULN, and might underestimate the proportion of significant
fibrosis and
cirrhosis. A new set of cut-offs should be used to predict significant
fibrosis and
cirrhosis in this specific population.