Albumin platelet product as a novel score for liver fibrosis stage and prognosis

Abstract

Fibrosis-4 index, a conventional biomarker for liver fibrosis stage, is confounded by age and hepatitis activity grade. The current retrospective multicenter study aimed to formulate the novel indices of liver fibrosis by mathematically combining items of peripheral blood examination and to evaluate ability of prognosis prediction. After a novel index was established in a training cohort, the index was tested in a validation cohort. Briefly, a total of 426 patients were enrolled in a training cohort. Albumin and platelet most strongly correlated to fibrosis stage among blood examination. Albumin platelet product (APP) = Albumin × platelet/1000 could differentiate the four stages of liver fibrosis (p < 0.05). APP indicated fibrosis stage independent from hepatitis activity grade. A cut-off value = 4.349 diagnosed cirrhosis with area under ROC more than 0.8. Multivariate analysis revealed that smaller APP independently contributed to HCC prevalence and overall mortality. The results were validated in another 707 patients with HCV infection. In conclusion, APP was not confounded by age or hepatitis activity grade contrary to Fibrosis-4 index. APP is as simple as physicians can calculate it by pen calculation. The product serves physicians in managing patients with chronic liver disease.

Alcohol-related cancer morbidity and mortality are stratified using modified albumin platelet product

“…APP and mAPP were initially established using a training cohort of patients with a biopsy-proven staging of fibrosis 5 , with a cut-off value for cirrhosis determined as 4.349 and 2.484 for APP and mAPP, respectively. The cut-off value of APP stratified HCC-free survival and overall survival.…”

“…The secondary endpoint was defined as death from any cause. Cut-off values for APP and mAPP were determined based on the diagnostic thresholds for cirrhosis in patients with non-alcoholic etiologies, as reported in a previous study (APP = 4.349 and mAPP = 2.484 for cirrhosis) 5 .…”

“…APP was calculated using the following equation: albumin (g/L) × platelet (10 9 /L)/1000, and mAPP was calculated using the following equation: albumin (g/L) × platelet (10 9 /L)/(T-Bil (µmol/L) × 100) 5 . The ALBI score was calculated based on a calculation from a previous report: log 10 T-Bil (µmol/L) × 0.66 + albumin (g/L) × (− 0.085) 35 .…”

“…Previously, we reported that the albumin platelet product (APP), a simple byproduct of the serum albumin level and platelet count, indicates the staging of liver fibrosis, the stratification of HCC-free survival, and the overall survival of patients with chronic liver diseases, including hepatitis C and B viral infections (HCV and HBV, respectively), autoimmune hepatitis, and primary biliary cholangitis 5 . Furthermore, a modified version of APP (mAPP), a three-math construct constructed using serum albumin level, platelet count, and total bilirubin (T-Bil), is equivalent in its potential to diagnose advanced liver fibrosis and cirrhosis in the previous study.…”

The association between serum albumin and depression in chronic liver disease may differ by liver histology

“…Serum albumin is closely related with liver fibrosis and the albumin platelet product has been validated in liver fibrosis staging [ 41 ]. Furthermore, the functions of serum albumin, such as antioxidant and detoxification capacity and the ability to chelate metal ions, were compromised in patients with cirrhosis [ 42 ].…”