P-56 LOW ROLE OF NON-INVASIVE FIBROSIS ASSESSMENT USING FIB-4 AND APRI IN PATIENTS WITH AUTOIMMUNE HEPATITIS

Introduction

The evaluation with non-invasive tests (NIT) of liver fibrosis is a more accessible method to estimate risk in patients with liver disease. The APRI and FIB-4 are scores that use easily accessible laboratory variables. They have been validated mainly in viral hepatitis and non-alcoholic fatty liver (NAFLD), but their usefulness in autoimmune hepatitis (HAI) has been little studied.

Objective

To evaluate the usefulness of APRI and FIB-4 in the screening of significant fibrosis (SF) in patients with HAI.

Methods

Observational, cross-sectional and retrospective study that includes liver biopsies performed between 2015-2018. The presence and degree of fibrosis were recorded according to the METAVIR scale; F3-F4 is considered FS. Histological diagnoses and clinical data were recorded.

Results

93 HAI liver biopsies were analyzed; 80% women; average age 52 (18-82) years. Fibrosis present in 69% (F0: 29, F1: 12; F2: 10, F3: 15, F4: 27). FS at 45.2%. The diagnostic concordance (kappa index) of FS by biopsy and FIB-4 (> 3.25) was acceptable, but not for APRI (> 0.7). The ROC curve for APRI was only 0.58 and for FIB-4 0.75. With the cutoff of 0.7 the APRI had a sensitivity of 94%, but a specificity of only 10% and with the cutoff of 3.25 the FIB-4 had a sensitivity of 72% and specificity of 69%, for the diagnosis of FS.

Conclusion

In HAI the usefulness of NIT fibrosis evaluation using APRI and FIB-4 was scarce. FIB-4 could be more useful, but liver biopsy remains important for staging and prognosis.