• Anisyah Achmad Brawijaya University
  • Rara Amalia Fadiah University of Jenderal Soedirman
  • Mustofa Mustofa University of Jenderal Soedirman
  • Ayu Lestari Prihadi University of Jenderal Soedirman


Objective - The development of hepatitis B virus infection can lead to the asymptomatic liver fibrosis which is reversible, but can develop into cirrhosis or even carcinoma. Hence, laboratory markers are needed to acquire the incidence of fibrosis such as by using AST-to-Platelet Ratio Index (APRI), Fib-4, AST-ALT Ratio (AAR), Age-Platelet (AP) index, and Pohl score. The use of hepatotoxic drug is commonly found in hepatitis B patients that might increase the risk of liver damage. This study aimed to determine the prevalence of liver fibrosis and to discover the use of hepatotoxic drug in hepatitis B patients at Prof. Dr. Margono Soekardjo Purwokerto General Hospital.

Methods - This study used total sampling methods with descriptive qualitative and quantitative analysis. The source of data was medical records of hepatitis B patients from January 2012 to August 2013.

Results - The result showed that from 25 hepatitis B patients, the incidence of liver fibrosis was found in 8% patients based on APRI, 44% based on Fib-4, 60% based on AAR, 52% based on AP index, and 28% based on Pohl score. There were 12 kinds of hepatotoxic drugs with ranitidine (60%) as the drug most widely used and most of them used one kind of hepatotoxic drug.

Conclusions – Our study found that the incidence of liver fibrosis was found in hepatitis B patients which was measured based on APRI, Fib-4, AAR, AP index and Pohl score, beside that the use of hepatotoxic drug was commonly found among those patients.


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Jin W, Lin Z, Xin Y, Jiang X, Dong Q, Xuan S. Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis B-related fibrosis: A leading meta-analysis. BMC Gastroenterol 2012;12:14.

Aggarwal R, Ranjan P. Preventing and treating hepatitis B infection. BMJ 2004;329(7474):1080-6.

Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003;38(2):518-26.

Iredale JP. Models of liver fibrosis: Exploring the dynamic nature of inflammation and repair in a solid organ. J Clin Invest 2007;117(3):539-48.

Loaeza-del-Castillo A, Paz-Pineda F, Oviedo-Cárdenas E, Sánchez-Avila F, Vargas-Vorácková F. AST to platelet ratio index (APRI) for the noninvasive evaluation of liver fibrosis. Ann Hepatol 2008;7(4):350-7.

Baranova A, Lal P, Birerdinc A, Younossi ZM. Non-invasive markers for hepatic fibrosis. BMC Gastroenterol 2011;11:91.

Lammert C, Bjornsson E, Niklasson A, Chalasani N. Oral medications with significant hepatic metabolism at higher risk for hepatic adverse events. Hepatology 2010;51(2):615-20.

Lackner C, Struber G, Liegl B, Leibl S, Ofner P, Bankuti C, et al. Comparison and validation of simple noninvasive tests for prediction of fibrosis in chronic hepatitis C. Hepatology 2005;41(6):1376-82.

Prosser CC, Yen RD, Wu J. Molecular therapy for hepatic injury and fibrosis: where are we? World J Gastroenterol 2006;12(4):509-15.

Sato M, Suzuki S, Senoo H. Hepatic stellate cells: Unique characteristics in cell biology and phenotype. Cell Struct Funct 2003;28(2):105-12.

Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V, et al. FIB-4: An inexpensive and accurate marker of fibrosis in HCV infection comparison with liver biopsy and fibrotest. Hepatology 2007;46(1):32-6.

Shin WG, Park SH, Jang MK, Hahn TH, Kim JB, Lee MS, et al. Aspartate aminotransferase to platelet ratio index (APRI) can predict liver fibrosis in chronic hepatitis B. Dig Liver Dis 2008;40(4):267-74.

Giannini EG, Zaman A, Ceppa P, Mastracci L, Risso D, Testa R. A simple approach to noninvasively identifying significant fibrosis in chronic hepatitis C patients in clinical practice. J Clin Gastroenterol 2006;40(6):521-7.

Poynard T, Bedossa P. Age and platelet count: A simple index for predicting the presence of histological lesions in patients with antibodies to hepatitis C virus. METAVIR and CLINIVIR Cooperative Study Groups. J Viral Hepat 1997;4(3):199-208.

Cheung RC, Currie S, Shen H, Bini EJ, Ho SB, Anand BS, et al. Can we predict the degree of fibrosis in chronic hepatitis C patients using routine blood tests in our daily practice? J Clin Gastroenterol 2008;42(7):827-34.

McEvoy GK. AHFS Drug Information Handbook. USA: American Society of Health-System Pharmacists; 2008. p. 931.

Robin S, Sunil K, Rana AC, Nidhi S. Different models of hepatotoxicity and related liver diseases: A review. Int Res J Pharm 2012;3(7):86-95. Available from:

Swaroop T, Gowda S. Hepatotoxicity mechanisms and its biomarkers. Int J Pharm Chem Sci 2012;1(2):675-82. Available from:

Lewis JH. Drug-induce liver disease. Med Clin North Am 2000;84(5):1275-311.

Pandit A, Sachdeva T, Bafna P. Drug-induced hepatotoxicity: A review. J Appl Pharm Sci 2011;2(5):233-43. Available from:

Navarro VJ, Senior JR. Drug-related hepatotoxicity. N Engl J Med 2006;354(7):731-9.



How to Cite

Achmad, A., R. A. Fadiah, M. Mustofa, and A. L. Prihadi. “THE INCIDENCE OF LIVER FIBROSIS BASED ON NON-INVASIVE MARKERS AND HEPATOTOXIC DRUG USED IN HEPATITIS B PATIENTS”. Asian Journal of Pharmaceutical and Clinical Research, vol. 7, no. 5, Nov. 2014, pp. 287-90,



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