Relationship Of Fib-4 Index With Transient Elastography In Chronic Hepatitis C Patients Having Apri >= 0.5-<= 2 In A Resource-Limited Setting In Pakistan

Objective: We aimed to study the extent of liver fibrosis in chronic hepatitis C patients with indeterminate APRI score of >= 0.5 - <= 2 (between higher and lower cut off value) and correlate it to transient elastography (TE) and FIB 4 index. Method: A cross-sectional study, 80 patients with CHC mono infection, APRI score >= 0.5 - <= 2 were interviewed from the cohort visiting the CHC program clinic at a tertiary care hospital in Karachi, Pakistan. Data were analyzed using STATA 14.0 and R 3.5.2 and SPSS 24.0 software according to their capabilities. Result: Of 80 patients, 50 (62.5%) were females and 30 (37.5%) were males with mean (+/- SD) ages of 41.73 (+/- 11.5) years and 41.16 (+/- 9.24) years respectively. The FIB 4 value among indeterminate APRI was reported as 1.47 (IQR 1.05-2.43). TE categories was reported: F0-F1 (n = 29; 36%), F1-F2 (n = 10; 12.5%), F2 (n = 9; 11.2%) F3 (n = 13; 16.2%), F3-F4 (n = 1; 1.2%) F4 (n = 18; 22.5%). FIB4 had a moderate positive correlation with TE while a weak positive correlation was found between APRI and TE (0.488, P < 0.0001 and 0.289, P < 0.001, respectively). TE was taken as a gold standard and compared with FIB4. The model constructed reported FIB4 as a good prediction for liver fibrosis with diagnostic accuracy 72%. Conclusion: The combination of two serum markers proves to be a low-cost noninvasive testing strategy for CHC patients having an indeterminate APRI score. By being readily accessible both biochemical scores can simplify liver assessment in lower middle-income countries (LMIC) and help family physicians to take appropriate decisions about treatment initiation with minimum delays.