Non-invasive prediction of Liver fibrosis and cirrhosis

Simona Kasputytė, Monika Petraitytė, Arnas Karužas

Lithuanian University of Health Sciences, Department of Gastroenterology


Liver biopsy has traditionally been considered the gold standard for the evaluation of hepatic fibrosis and is used as a benchmark for initiating treatment. Liver biopsy is an invasive procedure, with a risk of rare but potentially life-threatening complications and it is prone to sampling errors. These limitations have led to the development of non-invasive methods. There are various serum based biomarkers in an algorithm model for estimation of liver fibrosis stage and to determine cirrhosis such as Bonacini score, Lok index, AP index, APRI, AAR index, Fibro Q, FIB4,  GUCI index, and King score.  The Bonacini score is one of the newest non-invasive marker which can be used to determine liver cirrhosis.  Aim: To evaluate prognostic significance of non-invasive markers determining the liver fibrosis and cirrhosis.Objectives: 1. To evaluate the Bonacini score, AP index, APRI, AAR index, Fibro Q, FIB4, Lok index, GUCI index, King score prognostic significance determining the liver cirrhosis. 2. To evaluate the correlation between non-invasive markers and stages of liver fibrosis and cirrhosis. 3. To evaluate which non-invasive marker has the highest prognostic significance determining the liver cirrhosis. Methodology: A retrospective study was held at the Lithuanian University of Health Sciences Gastroenterology Clinic. The total number of patients was 203. Patients who had liver fibrosis or cirrhosis were 103 and other patients were as control group. Liver biopsy was performed for these patients and determined stages of liver fibrosis (F1-F4) according to METAVIR. Analyzed data: age, platelets count, AST, ALT, INR, prothrombin. Non-invasive scores: Bonacini score, AP (Age-Platelet) index, APRI (AST to Platelet Ratio Index), AAR index, Fibro Q, FIB4, Lok index, GUCI (Göteborg University Cirrhosis index), King score were calculated by this data. Statistical analysis was performed using IBM SPSS Statistics 22 software package. Results: A total of 203 patients were enrolled in research. 103 (50,7%) patients had severe fibrosis (F3) or cirrhosis (F4) and the 100 (49,3%) patients were as control group of research. Cut off level of Bonacini score for cirrhosis was 6,5 (sens–78%, specif–84%, AUROC 0,961), of Lok score – 0,33 (sens–81,6%, specif–89%, AUROC 0,932), of FibroQ – 4,25 (sens–82,9%, specif–87,4%, AUROC 0,916), of FIB4 – 0,808 (sens–82,7%, specif–87,4%, AUROC 0,922). Bonacini, Lok, FibroQ, FIB4 scores had significantly high predictive value for liver cirrhosis (p<0,001). Bonacini, Lok, FibroQ, FIB4 parameters significantly (p<0,001) correlated with other scores as AP, APRI, King, GUCI index. AP index (r=0,702), APRI (r=0,266), King score (r=0,293), GUCI index (r=0,41) significantly (p<0,001) correlated with stages by METAVIR.Conclusions:  1. Non-invasive scores – Bonacini, Lok, FibroQ, FIB4 – had statistically significant predictive value for liver cirrhosis.  2. Bonacini, Lok, FibroQ, FIB4 parameters significantly correlated with other scores: AP index, APRI, King score, GUCI index, also correlated with stages of METAVIR. 3. According to area under the ROC curve the strongest predictive predictive value  for liver cirrhosis had Bonacini score.