Role of Non-Invasive Scoring Systems in Detecting Fibrosis in Chronic Hepatitis B

Objectives: Chronic hepatitis is a clinical and pathological condition defined by etiological, clinical, and pathological aspects, in which inflammation in the liver continues for more than six months. Hepatitis B virus is one of the most important causes of etiology. Although liver biopsy is accepted as the gold standard test, there is a need to search for an alternative method due to the risk of complications, invasiveness, and cost. Our aim in this study was; to evaluate the predictive value of calculating fibrosis four scores (FIB -4), age platelet index (API), AST ALT ratio (AAR), AST platelet ratio index (APRI), Hui score, Goteburg University cirrhosis index (GUCI) indices in relation to liver biopsy in patients with chronic hepatitis B diagnosis who have not received any treatment before. Methods: The study included treatment-naive cases who underwent liver biopsy at Ankara University School of Medicine Hospitals Gastroenterology Clinics between March 2013 and November 2017 and at Ankara City Hospital Gastroenterology Clinic between 2019-2021. Non-invasive scores of the cases were evaluated simultaneously with liver biopsy. Results: A total of 159 patients, 45 (28.3%) female and 114 (71.7%) male, were included in our study. Eight non-invasive fibrosis markers were used, including APRI, FIB-4, AAR, API, CDS, Lok, GUCI, and Hui. GUCI and Hui non-invasive fibrosis markers were numerically superior to all other parameters in differentiating mild hepatitis from severe hepatitis and patients with cirrhosis, without cirrhosis. In the comparison of area under - receiver operating characteristic (AUROC) values using the Hanley-McNeal test to differentiate the cirrhosis patient from the non-cirrhosis patient, statistical superiority was found only against AAR and API (p<0.001, p<0.001). Conclusion: Although many markers were found successful in our study, AUC values were not significantly superior to each other, and we determined that they could not be an alternative to liver biopsy on their own.