Comparative Efficiency of APRI vs. FIB-4 in Detecting Advanced Liver Fibrosis in NAFLD and NASH

Sadaf  Noureen; Hareem  Fatima; Amina Hasan  Butt; Abeeha  Zia; Muhammad Huzaifa  Abid; Iqra  Malik

doi:10.54112/bcsrj.v6i6.1874

Authors

Sadaf Noureen The Groves Medical Centre, New Malden, UK
Hareem Fatima Department of Medicine, Advanced Home Health Services, Islamabad, Pakistan
Amina Hasan Butt Department of General Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
Abeeha Zia Department of General Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
Muhammad Huzaifa Abid Department of General Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan
Iqra Malik Department of General Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i6.1874

Keywords:

Non-alcoholic Fatty Liver Disease, Liver Cirrhosis, Fibrosis, Elastography Biomarkers

Abstract

Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are significant causes of chronic liver disease, with the progression to advanced fibrosis (F3–F4) significantly impacting prognosis. Objective: To compare the diagnostic accuracy of APRI and FIB-4 scores in detecting advanced liver fibrosis (F3–F4) in NAFLD and NASH patients, using transient elastography (FibroScan) as the reference standard. Methods: This cross-sectional, observational study was conducted at Fauji Foundation Hospital from March 2024 to March 2025. A total of 120 adult patients aged between 18 and 70 years with a confirmed diagnosis of NAFLD or NASH were included in the study. All data were collected using a standardized form. Variables recorded included patient demographics (age, sex, body mass index), comorbidities such as diabetes and hypertension, and relevant laboratory values, specifically serum AST, ALT, and platelet counts. Results: Out of 120 patients, 42 (35%) had advanced fibrosis on fibroscan. The FIB-4 score showed superior diagnostic performance with an AUROC of 0.86 (95% CI: 0.79–0.91), sensitivity of 78.5%, specificity of 85.9%, PPV of 75.6%, and NPV of 87.5%. APRI showed an AUROC of 0.79 (95% CI: 0.71–0.86), sensitivity of 71.4%, specificity of 80.8%, PPV of 66.7%, and NPV of 84.4%. Subgroup analysis confirmed the consistent superiority of FIB-4 across age and diabetic status. FIB-4 also had a lower misclassification rate (15.8%) compared to APRI (21.7%). Conclusion: It is concluded that while both APRI and FIB-4 are practical non-invasive tools for assessing liver fibrosis in NAFLD/NASH, FIB-4 is more accurate in detecting advanced fibrosis. Its greater diagnostic power and stability across subgroups support its use as the preferred first-line fibrosis assessment tool in routine clinical practice.

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