Combined acoustic radiation force impulse, aminotransferase to platelet ratio index and Forns index assessment for hepatic fibrosis grading in hepatitis B

Table 1 Results of basic information and acoustic radiation force impulse/aspartate aminotransferase to platelet ratio index/Forns index of all examinees

Group	Age (yr)	Gender (male/female)	BMI	ARFI	APRI	Forns index
F0 (n = 40)	39.8 ± 11.45	30/10	22.91 ± 2.31	1.09 (1.01, 1.21)	0.19 (0.14, 0.28)	5.58 ± 1.33
F1 (n = 41)	33.07 ± 7.971	33/8	22.37 ± 2.24	1.19 (1.15, 1.28)1	0.34 (0.28, 0.44)1	5.60 ± 1.19
F2 (n = 52)	38.27 ± 7.662	43/9	22.26 ± 2.41	1.31 (1.21, 1.43)1,2	0.42 (0.32, 0.64)1	6.73 ± 1.091,2
F3 (n = 59)	39.83 ± 8.732	47/12	22.44 ± 2.57	1.52 (1.35, 1.64)1,2,3	0.45 (0.32, 0.86)1,2	7.58 ± 1.551,2,3
F4 (n = 54)	43.85 ± 10.811,2,3,4	44/10	22.35 ± 2.47	1.92 (1.74, 2.14)1,2,3,4	0.80 (0.51, 1.68)1,2,3,4	9.43 ± 2.301,2,3,4
χ2/F	7.907	0.947	0.477	176.043	107.992	49.501
P value	< 0.001	0.918	0.753	< 0.001	< 0.001	< 0.001

For age and Forns index, data were represented in mean ± SD. For ARFI and APRI data, results were exhibited in median ± quartile.

¹Means significant change against the F0 group;

²Means significant change against the F1 group;

³Means significant change against the F2 group;

⁴Means significant change against the F3 group. For gender, ARFI and APRI comparisons, size of test α’ = α/n = 0.005; for age and Forns index comparison, size of test α = 0.05. ARFI: Acoustic radiation force impulse; APRI: Aspartate aminotransferase to platelet ratio index; BMI: Body mass index.

Table 2 Correlations of non-invasive tests with histological fibrosis stage by rank correlation analysis

Histological staging	Noninvasive test	Correlation (Spearman coefficient)	95%CI	P value
METAVIR classification	ARFI	0.845	0.805-0.877	< 0.001
	APRI	0.641	0.561-0.709	< 0.001
	Forns index	0.644	0.564-0.711	< 0.001

ARFI: Acoustic radiation force impulse; APRI: Aspartate aminotransferase to platelet ratio index.

Table 3 Cut-off values of acoustic radiation force impulse and aspartate aminotransferase to platelet ratio index for the diagnosis of liver fibrosis (95%CI)

	≥ F1	≥ F2	≥ F3	F4
ARFI
Cut-off (m/s)	1.26	1.29	1.43	1.62
Sensitivity	76.2% (69.80-81.90)	83.6% (77.10-88.90)	82.3% (74.00-88.80)	90.7% (79.70-96.90)
Specificity	95.0% (83.10-99.40)	90.1% (89.50-97.60)	89.5% (83.00-94.10)	92.2% (87.40-95.60)
PPV	99.1% (96.20-99.90)	94.5% (91.90-99.10)	86.9% (79.10-92.70)	76.0% (64.40-86.30)
NPV	35.9% (22.50-47.40)	73.0% (63.10-81.40)	85.6% (78.60-91.00)	97.2% (93.70-99.10)
AUROC	0.90 (0.86-0.94)a	0.91 (0.87-0.95)a	0.94 (0.90-0.96)a	0.96 (0.93-0.98)a
APRI
Cut-off (m/s)	0.30	0.41	0.49	0.44
Sensitivity	84.0% (78.20-88.70)	68.5% (60.80-75.50)	63.7% (54.10-72.60)	83.3% (70.70-92.10)
Specificity	85.0% (70.20-94.30)	82.7% (72.70-90.20)	79.7% (71.90-86.20)	67.2% (70.10-73.80)
PPV	97.6% (94.20-99.30)	89.0% (82.20-93.80)	72.8% (62.90-81.20)	41.7% (32.30-51.60)
NPV	42.7% (30.00-56.10)	56.3% (46.80-65.40)	72.1% (64.00-79.20)	93.5% (87.90-97.00)
AUROC	0.92 (0.88-0.95)a	0.84 (0.79-0.89)a	0.79 (0.73-0.84)a	0.82 (0.76-0.86)a

^aP < 0.05 for all values. ARFI: Acoustic radiation force impulse; APRI: Aspartate aminotransferase to platelet ratio index; AUCROC: Area under the receiver operating characteristic curve; NPV: Negative predictive value; PPV: Positive predictive value.

Table 4 Binary logistic regression of two variables in hepatic fibrosis ≥ F2

Combination	Variable	RC	SD of RC	Wald	P value	OR	95%CI of OR
ARFI + APRI	ARFI	9.11	1.48	37.68	< 0.001	9085.54	494.92-166789.07
	APRI	5.03	1.30	15.07	< 0.001	153.01	12.07-1939.04
	Constant	-13.27	1.95	46.09	< 0.001	-	-
ARFI + Forns index	ARFI	8.67	1.44	36.16	< 0.001	5824.00	345.12-98280.97
	Forns index	0.70	0.17	16.27	< 0.001	2.01	1.43-2.82
	Constant	-15.08	2.08	52.68	< 0.001	-	-

ARFI: Acoustic radiation force impulse; APRI: Aspartate aminotransferase to platelet ratio index; OR: Odds ratio; RC: Regression coefficient.

Table 5 Comparing area under the receiver operating characteristic curve of acoustic radiation force impulse/acoustic radiation force impulse + aspartate aminotransferase to platelet ratio index/acoustic radiation force impulse + Forns index/acoustic radiation force impulse + aspartate aminotransferase to platelet ratio index + Forns index in patients with fibrosis stage ≥ F2

Comparison	AUROC	Difference	95%CI		Z	P value
			Lower limit	Upper limit
ARFI	0.913	0.027	0.008	0.046	2.770	0.006
ARFI + APRI	0.940
ARFI	0.913	0.020	0.001	0.040	2.091	0.037
ARFI + Forns index	0.933
ARFI	0.913	0.031	0.010	0.053	2.893	0.004
ARFI + APRI + Forns index	0.944
ARFI + APRI	0.940	0.007	-0.011	0.025	0.728	0.466
ARFI + Forns index	0.933
ARFI + APRI	0.940	0.005	-0.005	0.014	0.958	0.338
ARFI + APRI + Forns index	0.944
ARFI + Forns index	0.933	0.011	-0.001	0.023	1.789	0.074
ARFI + APRI + Forns index	0.944

AUROC: Area under the receiver operating characteristic curve; ARFI: Acoustic radiation force impulse; APRI: Aspartate aminotransferase to platelet ratio index.