Optimized cutoffs improve performance of the aspartate aminotransferase to platelet ratio index for predicting significant liver fibrosis in human immunodeficiency virus/hepatitis C virus co-infection

Division of Gastroenterology-Hepatitis Section, Federal University of Sao Paulo, Sao Paulo, Brazil.
Liver international: official journal of the International Association for the Study of the Liver (Impact Factor: 4.85). 04/2008; 28(4):486-93. DOI: 10.1111/j.1478-3231.2008.01675.x
Source: PubMed


To assess the diagnostic value of modified cutoffs for aspartate aminotransferase to platelet ratio index (APRI) to predict significant liver fibrosis in human immunodeficiency virus (HIV)/hepatitis C virus (HCV) patients.
This retrospective cross-sectional study included consecutive patients with HIV/HCV co-infection who underwent percutaneous liver biopsy. The accuracy of APRI for the diagnosis of significant fibrosis (F2/F3/F4 METAVIR) was evaluated by estimating the positive and negative predictive values (PPV and NPV respectively) and by measuring the area under the receiver operating characteristics curve (AUROC).
One hundred and eleven patients were included (73% men, mean age 40.2+/-7.8 years). Significant fibrosis was observed in 45 patients (41%). To discriminate these subjects, the AUROC of APRI was 0.774+/-0.045. An APRI > or = 1.8 showed a PPV of 75% for the presence of significant fibrosis, and an index < 0.6 excluded significant fibrosis with an NPV of 87%. If biopsy indication was based only on APRI and restricted to scores in the intermediate range (> or = 0.6 and < 1.8), 46% of liver biopsies could have been avoided as compared with 40% using the classical cutoffs.
APRI with adjusted cutoffs can predict significant liver fibrosis in patients with HIV/HCV co-infection and might obviate the need to perform a biopsy in a considerable percentage of those subjects.

7 Reads
  • Source
    • "In Wai and colleagues' original study [6], the AUC for HCV-related significant fibrosis and cirrhosis in the training and validation cohorts were 0.80 to 0.88 and 0.89 to 0.94, respectively. Subsequently, many researches supported this view [31-35]. A meta analysis researched by Abdel Aziz M et al. pointed out, in patients with chronic viral hepatitis C (CHC), the summary AUCs of the APRI for significant fibrosis and cirrhosis were 0.76 [95% CI: 0.74-0.79] "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aspartate aminotransferase-to-platelet ratio index (APRI), a tool with limited expense and widespread availability, is a promising noninvasive alternative to liver biopsy for detecting hepatic fibrosis. The objective of this study was to systematically review the performance of the APRI in predicting significant fibrosis and cirrhosis in hepatitis B-related fibrosis. Areas under summary receiver operating characteristic curves (AUROC), sensitivity and specificity were used to examine the accuracy of the APRI for the diagnosis of hepatitis B-related significant fibrosis and cirrhosis. Heterogeneity was explored using meta-regression. Nine studies were included in this meta-analysis (n = 1,798). Prevalence of significant fibrosis and cirrhosis were 53.1% and 13.5%, respectively. The summary AUCs of the APRI for significant fibrosis and cirrhosis were 0.79 and 0.75, respectively. For significant fibrosis, an APRI threshold of 0.5 was 84% sensitive and 41% specific. At the cutoff of 1.5, the summary sensitivity and specificity were 49% and 84%, respectively. For cirrhosis, an APRI threshold of 1.0-1.5 was 54% sensitive and 78% specific. At the cutoff of 2.0, the summary sensitivity and specificity were 28% and 87%, respectively. Meta-regression analysis indicated that the APRI accuracy for both significant fibrosis and cirrhosis was affected by histological classification systems, but not influenced by the interval between Biopsy & APRI or blind biopsy. Our meta-analysis suggests that APRI show limited value in identifying hepatitis B-related significant fibrosis and cirrhosis.
    Full-text · Article · Feb 2012 · BMC Gastroenterology
  • [Show abstract] [Hide abstract]
    ABSTRACT: The APRI and FIB-4 index are markers that have been proposed for the evaluation of hepatic fibrosis in patients co-infected with HIV and HCV. We retrospectively compared these 2 indices in 81 co-infected patients staged by liver biopsy. The FIB-4 index was superior to the APRI for the differentiation of mild from significant fibrosis in both predictive values and area under the receiver operator curve (AUROC). The tests were comparable for the differentiation of mild/moderate from advanced fibrosis. These tests could be used to evaluate co-infected patients for treatment, and exclude those that do not need periodic screening for hepatocellular carcinoma.
    No preview · Article · Aug 2008 · Clinica Chimica Acta
  • [Show abstract] [Hide abstract]
    ABSTRACT: An intensive research effort in the field of non-invasive evaluation of liver fibrosis has recently permitted the description and validation of several serum markers of fibrosis, mainly in chronic hepatitis C patients. In addition to the commonly used tests such as FibroTest or FibroMeters, other either indirect (aspartate aminotransferase, prothrombin time, platelets) or direct (PIIINP, hyaluronic acid, metalloproteinases) markers, usually used in combination, have been evaluated. Simple scores such as APRI or FIB-4 have also been widely studied and have revealed interesting, albeit non-comprehensive, data on liver fibrosis, especially in terms of significant, extensive fibrosis or cirrhosis. These simple scores may be proposed as a first-line investigation, bearing in mind their limitations and comparing them with more accurate methods for evaluating liver fibrosis if necessary. Other scores, including direct serum markers, which can be difficult to assess, have given disappointing results that, in general, were either similar to, or only slightly better than, the results of the simpler tests. Further studies are needed to identify new markers that are more accurate and, above all, able to predict the outcome of liver fibrosis.
    No preview · Article · Sep 2008 · Gastroentérologie Clinique et Biologique
Show more