COMPARISON OF GAMMA GLUTAMYL TRANSPEPTIDASE TO PLATELET RATIO (GPR), INR TO PLATELET RATIO (INPR), APRI, AND FIB-4 IN PREDICTING ADVANCED LIVER FIBROSIS IN HEPATITIS C POPULATION

Abstract

Background: Hepatitis C virus (HCV) infection is a major global health concern, leading to progressive liver fibrosis, cirrhosis, and hepatocellular carcinoma. Early and accurate assessment of advanced liver fibrosis is essential for timely intervention and optimized patient management. While liver biopsy remains the gold standard, its invasiveness limits its routine use. Non-invasive fibrosis markers, including the Gamma Glutamyl Transpeptidase to Platelet Ratio (GPR), INR to Platelet Ratio (INPR), Aspartate Aminotransferase to Platelet Ratio Index (APRI), and Fibrosis-4 (FIB-4) index, offer practical alternatives. This study aimed to compare the diagnostic accuracy of these four indices in predicting advanced liver fibrosis in HCV patients.

Objective: To evaluate and compare the diagnostic accuracy of INPR, GPR, APRI, and FIB-4 in predicting advanced liver fibrosis among HCV patients using shear wave elastography (SWE) as the reference standard.

Methods: This cross-sectional study was conducted at the Hepatogastroenterology Department, Sindh Institute of Urology and Transplantation, from April to September 2024. A total of 210 adult patients with chronic HCV infection underwent fibrosis assessment using SWE. Fibrosis severity was categorized into non-advanced (F1-F2) and advanced (F3-F4). Non-invasive fibrosis indices were calculated, and diagnostic performance was assessed using receiver operating characteristic (ROC) analysis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for each index.

Results: Among 210 patients (mean age 43.7 ± 12.6 years; 62.9% male), advanced fibrosis was detected in 125 (59.5%). INPR exhibited the highest diagnostic accuracy (AUROC = 0.807, sensitivity = 83.4%, specificity = 60.8%, PPV = 73.4%, NPV = 62.2%). GPR showed an AUROC of 0.782, with the highest sensitivity (95.2%), specificity of 44.7%, PPV of 71.7%, and NPV of 86.3%. APRI demonstrated an AUROC of 0.744 (sensitivity = 90.4%, specificity = 51.8%, PPV = 73.4%, NPV = 78.6%), while FIB-4 had the lowest AUROC (0.669), with sensitivity and specificity of 81.2% and 35.3%, respectively.

Conclusion: INPR demonstrated the highest diagnostic accuracy, making it a preferred non-invasive marker for detecting advanced fibrosis. GPR, with its high sensitivity, emerged as a valuable rule-out test. APRI and FIB-4 exhibited moderate accuracy, warranting cautious interpretation. These findings reinforce the clinical utility of non-invasive fibrosis indices in optimizing liver fibrosis assessment and guiding HCV management strategies.