APRI and FIB-4 in the evaluation of liver fibrosis in chronic hepatitis C patients stratified by AST level

Yen, Yi‐Hao; Kuo, Fang Ying; Kee, Kwong Ming; Chang, Ko‐Wei; Tsai, Ming Chao; Hu, Tsung Hui; Lu, Sheng; Wang, Jing Houng; Hung, Chao Hung; Chen, Chien Hung

doi:10.1371/journal.pone.0199760

Cited by 57 publications

(38 citation statements)

References 31 publications

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“…[2] Simple and accurate liver fibrosis assessment other than TE examination that can be done in remote area is essential. [16,17] Two studies, both in Italy, had contradictory results. Mazzola, et al demonstrate the unreliability of APRI and FIB-4 for the assessment of cirrhosis while Merli, et al…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of APRI and FIB-4 for Confirming Cirrhosis in Indonesian HIV/HCV Co-infected Patients

Yunihastuti

Wicaksana

Wiraguna

et al. 2020

Preprint

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BackgroundAfter successful of antiretroviral therapy, highly effective direct acting antiviral (DAA) make HCV elimination reasonable in HIV/HCV co-infected patients. However, in achieving this target, there are still barriers to start DAA treatment, particularly in the area of liver fibrosis assessment that determine the duration of therapy. We aimed to assess the diagnostic performance of APRI and FIB-4 for diagnosing cirrhosis in HIV/HCV co-infected patients using hepatic transient elastography (TE) as gold standard.MethodThis is an retrospective study on HIV/HCV co-infected patients who concomitantly performed hepatic TE measurement, APRI, and FIB-4 evaluation before HCV treatment initiation at a tertiary hospital in Jakarta from 2014 to 2019. Sensitivity, specificity and diagnostic accuracy of indirect biomarkers for liver stiffness measurement (LSM) ≥ 12.5 kPa was determined by receiver operator characteristics curves. Results233 HIV/HCV co-infected patients on stable antiretroviral therapy were included, of whom 91.5% were male with mean age of 37 (SD 5) years. Only 28.7% of patients were classified as cirrhosis (F4). Using TE as gold standard (≥12.5 kPa), the low threshold of APRI (1) had specificity 95%, sensitivity 48.4%, correctly classified 81.6% of patients, with moderate performance, AUROC at 0.72 (95% CI 0.63-0.80). The optimal cut-off of FIB-4 was 1.66 [specificity 92.5%, sensitivity 53.1%, AUROC at 0.73 (95% CI 0.65-0.81)] and correctly classified 81.1% of the patients.ConclusionAPRI score > 1 and FIB-4 score > 1.66 had moderate performance with high specificity in diagnosing cirrhosis. These biochemical markers could be used while TE is not available.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of APRI and FIB-4 for Confirming Cirrhosis in Indonesian HIV/HCV Co-infected Patients

Yunihastuti

Wicaksana

Wiraguna

et al. 2020

Preprint

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“…The body mass index (BMI), aspartate aminotransferase to platelet ratio index (APRI), and Fibrosis-4 (FIB-4) score were calculated as described earlier [9] . A FIB-4 < 1.45 indicates absence of cirrhosis and > 3.25 indicates cirrhosis.…”

Section: Laboratory Testsmentioning

confidence: 99%

Baseline Characteristics and Treatment Cost of Hepatitis C at Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam in Direct-Acting Antiviral Treatment Era

Nguyen

Tran

Nghiem

et al. 2019

Journal of Gastroenterology and Hepatology Research

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hepatitis C virus (HCV) infection in Vietnam in 2016. Since then, Hospital for Tropical Diseases (HTD), Ho Chi Minh City, Vietnam introduced DAAs based treatment for all newly presented chronic HCV patients. Here, we report the sociodemographic, clinical, biochemical, and virologic characteristics of patients and the direct medical cost associated with DAAs treatment. METHODS: We conducted a retrospective cross-sectional study among chronic HCV patients attended at HTD from March 2016 to October 2017 and treated with DAAs. We used an extract of the patient's electronic medical record containing demographics, clinical presentations, laboratory results, drug prescription, and cost of treatment at the hospital for data analysis. RESULTS: 2817 chronic HCV patient received DAAs treatment during the study period. The mean age was 55.0 years, and 54.9% (1546/2817) of the patients were female. HCV genotype 1, 2, 3 and 6 prevalence was 32.1% (904/2817), 12.7% (359/2817), 0.4% (10/2817), and 54.7% (1542/2817) respectively. The mean HCV viral load was 3.1 × 10 6 copies/ml, including 46.9% (1322/2817) had ≥10 6 copies/ml. 70.64% (1990/2817) and 16.15% (455/28817) of the patients received Sofosbuvir (SOF)/Ledipasvir (LDV) ± Ribavirin (RBV) and SOF/Daclatasvir (DCV) ± RBV therapy respectively.

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“…[18] Simple and accurate liver fibrosis assessment other than TE examination that can be done in remote area is essential. [19,20] Since the Indonesian government planned to expand free DAA program for HCV, the result our study could be implemented in many places, as WHO also recommends to use APRI and FIB-4 in resourceconstraint countries. [2,14] This study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of APRI and FIB-4 for Confirming Cirrhosis in Indonesian HIV/HCV Co-infected Patients

Yunihastuti

Wicaksana

Wiraguna

et al. 2020

Preprint

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Background: After successful of antiretroviral therapy, highly effective direct acting antiviral (DAA) make HCV elimination reasonable in HIV/HCV co-infected patients. However, in achieving this target, there are still barriers to start DAA treatment, particularly in the area of liver fibrosis assessment that determine the duration of therapy. We aimed to assess the diagnostic performance of APRI and FIB-4 for diagnosing cirrhosis in HIV/HCV co-infected patients using hepatic transient elastography (TE) as gold standard.Method: This is a retrospective study on HIV/HCV co-infected patients who concomitantly performed hepatic TE measurement, APRI, and FIB-4 evaluation before HCV treatment initiation at a tertiary hospital in Jakarta from 2014 to 2019. Sensitivity, specificity and diagnostic accuracy of indirect biomarkers for liver stiffness measurement (LSM) ≥ 12.5 kPa was determined by receiver operator characteristics curves. Results: 223 HIV/HCV co-infected patients on stable antiretroviral therapy were included, of whom 91.5% were male with mean age of 37 (SD 5) years. Only 28.7% of patients were classified as cirrhosis (F4). Using TE as gold standard (≥12.5 kPa), the low threshold of APRI (1) had specificity 95%, sensitivity 48.4%, correctly classified 81.6% of patients, with moderate performance, AUC at 0.72 (95% CI 0.63-0.80). The optimal cut-off of FIB-4 was 1.66 [specificity 92.5%, sensitivity 53.1%, AUC at 0.73 (95% CI 0.65-0.81)] and correctly classified 81.1% of the patients.Conclusion: APRI score > 1 and FIB-4 score > 1.66 had moderate performance with high specificity in diagnosing cirrhosis. These biochemical markers could be used while TE is not available.

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APRI and FIB-4 in the evaluation of liver fibrosis in chronic hepatitis C patients stratified by AST level

Cited by 57 publications

References 31 publications

Diagnostic Performance of APRI and FIB-4 for Confirming Cirrhosis in Indonesian HIV/HCV Co-infected Patients

Diagnostic Performance of APRI and FIB-4 for Confirming Cirrhosis in Indonesian HIV/HCV Co-infected Patients

Baseline Characteristics and Treatment Cost of Hepatitis C at Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam in Direct-Acting Antiviral Treatment Era

Diagnostic Performance of APRI and FIB-4 for Confirming Cirrhosis in Indonesian HIV/HCV Co-infected Patients

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