Abstract
OBJECTIVE: This study aimed to evaluate the severity of liver fibrosis in chronic liver disease patients using aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 (FIB-4), FibroScan, and the Child-Turcotte-Pugh (CTP) score. It emphasized assessing fibrosis progression toward cirrhosis (F4 stage) and exploring the correlation between non-invasive markers and the CTP score for liver function and prognosis. METHODOLOGY: This observational cross-sectional study was conducted over one calendar year in the Department of Medicine at Baba Raghav Das (BRD) Medical College, Gorakhpur, India. A total of 200 patients with chronic liver disease were selected. Fibrosis scores were calculated using FibroScan, APRI, and FIB-4, while the modified CTP score was determined for each participant. Pearson's correlation was used to assess relationships between variables, while logistic regression evaluated the association of non-invasive methods (APRI, FIB-4, FibroScan) with severe fibrosis (F4). Odds ratios (ORs), sensitivity, specificity, and AUC were calculated, and ROC curves visualized their discriminative ability. Statistical significance was defined as p < 0.05. RESULTS: The study revealed a predominance of advanced fibrosis (F4) in males (82.5%) and patients with ethanol-induced liver disease (84.6%). FIB-4 had the strongest predictive value for advanced fibrosis with an OR of 3.8 (95% CI: 3.0-4.5) and AUC of 0.743, followed by APRI with an OR of 2.5 (95% CI: 1.9-3.1) and AUC of 0.757. CTP showed the highest sensitivity (95.45%) but a lower AUC (0.697), indicating its clinical value in correlating fibrosis severity with liver dysfunction. Hemoglobin, platelets, and INR showed no significant correlation with fibrosis, while total bilirubin was elevated in advanced CTP classes. A moderate positive correlation (r = 0.481, p < 0.001) was observed between fibrosis scores and CTP, linking fibrosis severity with liver dysfunction. These findings emphasize FIB-4's superior predictive accuracy, while APRI and CTP remain valuable complementary tools for liver disease prognosis. CONCLUSION: In conclusion, FIB-4 is the most accurate for staging advanced fibrosis, while APRI excels in initial screening due to its higher sensitivity. FibroScan effectively assesses direct fibrosis, and the CTP score adds prognostic value, making these methods complementary for managing chronic liver diseases.