Evaluation of non-invasive markers of liver fibrosis in chronic hepatitis B patients in a sub- saharan African setting: Transient elastography Versus APRI, FIB4, GTT/ Platelet scores

Abstract Background: Non-invasive markers which use routine laboratory tests are less expensive and highly needed to assess and stage liver fibrosis in chronic hepatitis B patients in Sub Saharan Africa. We aimed at evaluating liver fibrosis, using Aspartate aminotransferase to Platelet Ratio Index (APRI), Fibrosis Index Based on 4 factors (FIB4), and Gamma glutamyl transpeptidase to Platelet Ratio (GPR) in chronic hepatitis B patients with transient elastography as the reference so as to choose an alternative to transient elastography. Method: We carried out a cross-sectional study using the records of patients who attended the Douala General Hospital and Marie O Polyclinic Douala between 2012 to 2017. Non-invasive tests were compared with Transient Elastography. The spearman coefficient was used to determine correlation. The sensitivity, specificity, positive predictive values and negative predictive values were used to get the optimal cut off values. The diagnostic accuracy was estimated by calculating the area under the Receiver Operating Characteristic Curve (ROC). P<0.05 was considered statistically significant. Results: Of the 243 patient records studied, the median age or inter quartile range (IQR) was 35(29-42) years with a male predominance of 73.7%. More than 60% of the study population had normal transaminases. Significant fibrosis was found in 88(36.2%) patient and 32(13.7%) patient had cirrhosis. APRI had the best cut off values and highest area under the ROC Curve, for significant fibrosis and cirrhosis with 0.55(0.823 95% CI [0.769-0.869], P<0.001) and 0.65(0.84 95% CI [0.788-0.884], P<0.005) respectively. Conclusion: APRI, had the best diagnostic properties to detect liver fibrosis and cirrhosis in patients with Chronic Hepatitis B in Douala. The cut off values are 0.55 and 0.65 for significant fibrosis and cirrhosis respectively.