The Silent Face of Chronic Hepatitis B - Biopsy-Supported Fibrosis Detection and the Reliability of Non-Invasive Scores (FIB-4, APRI) in Inactive, Gray Zone, and Immune-Tolerant Cases

Q: What problem does the study address about chronic hepatitis B?

It evaluates whether non-invasive fibrosis scores can reliably predict liver fibrosis in CHB “silent” phases where classification and histology may not align with standard criteria.

Q: How were patients selected and how was fibrosis assessed?

A retrospective cross-sectional study included 230 CHB patients who underwent liver biopsy, and fibrosis categories were based on histologically confirmed stages (F<3 vs F≥3).

Q: What did the study find about FIB-4 and APRI performance?

Both FIB-4 and APRI were higher in patients with fibrosis stage ≥3, with AUC values of about 0.70 for FIB-4 and 0.68 for APRI, and a negative predictive value of 87%. The authors conclude these tools help rule out advanced fibrosis but are supportive rather than definitive alternatives to biopsy.

Sep 28, 2026

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Study evaluates diagnostic performance of the non-invasive fibrosis scores FIB-4 and APRI for predicting liver fibrosis among chronic hepatitis B patients in immune-tolerant, inactive, and gray zone phases. A retrospective cross-sectional design enrolled 230 patients who underwent liver biopsy, with groups defined by FIB-4 and APRI cutoffs (<3 vs ≥3.3). ROC analysis assessed accuracy, reporting AUC values around 0.68–0.70 and a negative predictive value of 87%.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Background

Introduction

Material and Methods

Results

Conclusions

CLINICAL RESEARCH e-ISSN 1643-3750 © Med Sci Monit, 2025; 31: e951084 DOI: 10. 12659/MSM.951084 Received: 2025.08.10 Accepted: 2025.10.04 Available online: 2025.10.20 Published: 2025.12.14 Authors’ Contribution: Study Design A Data Collection B Statistical Analysis C Data Interpretation D Manuscript Preparation E Literature Search F Funds Collection G ABCDEFG Corresponding Author: Financial support: Conflict of interest: The Silent Face of Chronic Hepatitis B: BiopsySupported Fibrosis Detection and the Reliability of Non-Invasive Scores (FIB-4, APRI) in Inactive, Gray Zone, and Immune-Tolerant Cases Mehmet Kasım Aydın Department of Gastroenterology, Faculty of Medicine, Mersin University, Mersin, Türkiye Mehmet Kasım Aydın, [e-mail:](e-mail: mkasim.aydin3321@gmail.com)[ mkasim.aydin3321@gmail.com](e-mail: mkasim.aydin3321@gmail.com) None declared None declared Background: This study sought to evaluate the diagnostic performance of the non-invasive fibrosis scores Fibrosis-4 Index (FIB-4) and Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) in predicting liver fibrosis among patients with chronic hepatitis B (CHB) in immune-tolerant, inactive, and gray zone phases. Material/Methods: This retrospective cross-sectional study included 230 patients with CHB, as determined by laboratory and clinical criteria, and who underwent liver biopsy. Patients were grouped based on FIB-4 and APRI fibrosis scores of <3 and ³3. The FIB-4 and APRI scores were calculated, and their diagnostic accuracy was assessed, using receiver operating characteristic (ROC) curve analysis. Results: The mean age of the patients was 44.4±12.2 years, and 53.9% were female. A total of 37.4%(86/230) of the patients met the criteria for treatment. Both FIB-4 (1.53±0.90 vs 0.91±0.55, P=0.003) and APRI (0.44±0.23 vs 0.29±0.15, P=0.001) scores were significantly higher in patients with fibrosis score ³3. The area under the curve (AUC) was 0.70 (cut-off >1.06) for FIB-4 and 0.68 (cut-off >0.38) for APRI. Both scores had a negative predictive value of 87%. The difference between AUC values was not statistically significant (P=0.80). Conclusions: FIB-4 and APRI are helpful non-invasive tools for ruling out advanced fibrosis in CHB patients. However, due to their limited diagnostic power, they should be considered as supportive tools rather than definitive alternatives to liver biopsy. Keywords: Chronic Disease • Fibrosis • Hepatitis B • Statistics Full-text PDF: [https://www.medscimonit.com/abstract/index/idArt/951084](https://www.medscimonit.com/abstract/index/idArt/951084) 2034 4 1 17 Publisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher This work is licensed under Creative Common AttributionNonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) e951084-1 Indexed in: [Current Contents/Clinical Medicine] [SCI Expanded] [ISI Alerting System][ISI Journals Master List] [Index Medicus/MEDLINE] [EMBASE/Excerpta Medica][Chemical Abstracts/CAS] CLINICAL RESEARCH Aydın M.K.: Non-invasive detection of hepatitis B © Med Sci Monit, 2025; 31: e951084 Introduction Chronic hepatitis B (CHB) infection remains one of the leading causes of liver cirrhosis and hepatocellular carcinoma worldwide. Its natural course consists of 4 phases: immune-tolerant, immune-active, inactive carrier, and reactivation [1,2]. The immune-tolerant phase is marked by elevated hepatitis B virus (HBV) DNA and positive Hepatitis B Virus Early Antigen (HBeAg), while alanine aminotransferase (ALT) remains normal. In contrast, the inactive phase is defined by HBeAg negativity, low HBV DNA levels (<2000 IU/mL), and normal ALT va

FAQs

What problem does the study address about chronic hepatitis B?

It evaluates whether non-invasive fibrosis scores can reliably predict liver fibrosis in CHB “silent” phases where classification and histology may not align with standard criteria.

How were patients selected and how was fibrosis assessed?

A retrospective cross-sectional study included 230 CHB patients who underwent liver biopsy, and fibrosis categories were based on histologically confirmed stages (F<3 vs F≥3).

What did the study find about FIB-4 and APRI performance?

Both FIB-4 and APRI were higher in patients with fibrosis stage ≥3, with AUC values of about 0.70 for FIB-4 and 0.68 for APRI, and a negative predictive value of 87%. The authors conclude these tools help rule out advanced fibrosis but are supportive rather than definitive alternatives to biopsy.

Sep 28, 2026

Uploaded by Well Done