FIB4 Could Help Exclude Significant Fibrosis in Chronic HBV Patients

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NLR values were similar between significant and minimal fibrosis and were not correlated with significant fibrosis.

There are very few studies showing heterogeneous results for the performance and diagnostic accuracy of laboratory-based markers for fibrosis prediction patients with chronic hepatitis B virus (HBV).1

A team, Fadi Abu Baker, Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Technion Faculty of Medicine, looked at the performance of the FIB-4 and neutrophil-to-lymphocyte ratio (NLR) markers for the differentiation between significant and non-significant hepatic fibrosis in real-life practice.

The Study

In the study, the investigators prospectively recruited patients with chronic HBV attending the hepatology clinic. Each participant underwent shear wave elastography (SWE) and blood tests.

The investigators assessed the predictive accuracy of FIB-4 and NLR for liver fibrosis by receiver operating characteristics (ROC) analysis.

The study included 174 fully characterized patients with chronic HBV and an average age of 50.2±11.2. The patient population was 65.2% male.

The results show 23% of patients had significant fibrosis of at least 2 F2 per SWE (>7.1KPA).

There was a significant and linear correlation between the SWE score and FIB-4 values (r = 0.572; P <0.001).

A lower cut-off of 1.43 yielded an area under the receiver operating characteristic (AUROC) of 0.76, with a sensitivity of 68.8%, specificity of 79.8%, diagnostic accuracy of 78.5%, and NPV of 96%.

On the other hand, NLR values were similar between significant and minimal fibrosis and were not correlated with significant fibrosis (r = 0.54; P = 0.39).

“FIB4 has a moderate performance and may have a valuable role in excluding significant fibrosis in CHB patients in daily practice,” the authors wrote.

WHO Goals

In recent years the World Health Organization (WHO) put forth goals to eliminate hepatitis B targets as part of the Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance).2

In a 2022 study, which was part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, investigators used population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. The investigators estimated chronic HBV infection and the burden of HBV-related disease, which was defined as an aggregate of cirrhosis because of hepatitis B, liver cancer because of hepatitis B, and acute hepatitis B.

In 2019, the last year of the study, the investigators estimated the global, all-age prevalence of chronic HBV infections was 4.1% (95% UI, 3.7-4.5). This equates to 316 million (284-351 million) infected individuals.

They also found a 31.3% (29-33.9%) decline in the all-age prevalence between 1990-2019. There was a more marked decline of 76.8% (76.2-77.5%) in the prevalence of children younger than 5 years.

In total, there were 555,000 (487,000-630,000) global deaths due to HBV-related diseases in 2019, while the number of HBV-related deaths increased between 1990-2019 by 5.9% (-5.6 to 19.2%).

Between 2015-2019 the number of HBV-related deaths increased by 2.9% (-5.9 to 11.3%). However, all-age and age-standardized death rates because of HBV-related diseases decreased during these periods.


ABU BAKER, F., TAHER NATOUR, R., KOPELMAN, Y., ALKILANI, A. H., & ABU MOUCH, S. (2023). Performance of serum-based biomarkers in fibrosis prediction of chronic hepatitis B patients in real life practice. Minerva Gastroenterology.

Walter, K. (2022, June 22). Chronic hepatitis B infections decreasing in recent years. HCP Live.