The Open Microbiology Journal

ISSN: 1874-2858 ― Volume 14, 2020

Investigating the Efficiency of APRI, FIB-4, AAR and AARPRI as Noninvasive Markers for Predicting Hepatic Fibrosis in Chronic Hepatitis B Patients in Bangladesh

Fazley R. Sha1, #, Moyen Uddin Pk1, 2, 3, 4, 5, *, #, Nermeen Z. Abuelezz6, Rumana Pervin1, Rabiul I. Talukder4, Momtaj Begum7, Matiar Rahman1
1 Institute of Biological Science, Rajshahi University, Dhaka, Bangladesh
2 Department of Biochemistry & Molecular Biology, Rajshahi University, Dhaka, Bangladesh
3 Department of Biochemistry, Independent University, Dhaka, Bangladesh
4 Department of Biochemistry, Primeasia University, Dhaka, Bangladesh
5 Department of Clinical Biochemistry, Anwer Khan Modern Medical College & Hospital Ltd, Dhaka, Bangladesh
6 Department of Biochemistry, College of pharmaceutical sciences and drug manufacturing, Misr University for Science and Technology, Misr, Egypt
7 Rajshahi Nursing College, Rajshahi Medical College & Hospital Ltd, Dhaka, Bangladesh


Background and Aims:

Accurate, affordable non-invasive markers are highly needed for efficient diagnosis and management of liver fibrosis caused by chronic hepatitis B. This is the first study to investigate the diagnostic efficiency of Aspartate Transaminase to Platelet Ratio (APRI), Fibrosis Index (FIB-4), Aspartate transaminase to Alanine Transaminase Ratio (AAR) and AAR/Platelet ratio index (AARPRI) as non-invasive markers to predict hepatic fibrosis caused by Chronic Hepatitis B (CHB) in Bangladesh.


In this study, a training cohort of 1041 CHB patients were recruited, whereas 104 and 109 CHB patients of matched ages were recruited as internal and external validation cohort groups respectively. Histological and hematological data were analyzed. METAVIR scoring system was used to classify liver fibrosis stages. Area Under Receiver Operating Curve (AUROC), correlations and cutoff values for the four diagnostic markers were calculated and assessed.


92%, 81% and 84% of the patients had liver fibrosis in the training cohort, internal and external cohort groups respectively. Among the four noninvasive panels, APRI showed the best area under ROC; (0.767, CI: 0.780-0.914; 0.775) for the training cohort, (0.775, CI: 0.693-0.857), and (0.847, CI: 0.780-0.914) for the internal and external cohorts respectively. Cut-off value of APRI was 0.512 with sensitivity/specificity of 84%/67% in training cohort, 81% / 66% in the internal cohort, and 88% / 66% in an external cohort. The odds ratio for APRI was 32.95 (95%CI: 4.746-228.862, p<0.001).


Among all the four tested markers, APRI is the most accurate non-invasive test to predict major liver fibrosis (F2-3) in Bangladeshi CHB patients.

Keywords: Chronic hepatitis B, Noninvasive markers, METAVIR score, Liver fibrosis, Odds ratio, Liver cirrhosis.

Article Information

Identifiers and Pagination:

Year: 2019
Volume: 13
First Page: 34
Last Page: 40
Publisher Id: TOMICROJ-13-34
DOI: 10.2174/1874285801913010034

Article History:

Received Date: 14/11/2018
Revision Received Date: 26/01/2019
Acceptance Date: 05/02/2019
Electronic publication date: 28/02/2019
Collection year: 2019

© 2019 Sha et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Rajshahi University, Bangladesh; E-mail:
#Equal contributions

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