Aspartate transaminase to platelet ratio index (APRI) but not FIB-5 or FIB-4 is accurate in ruling out significant fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) in an urban slum-dwelling population

Abstract

Background and aimsNon-invasive assessment of fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) is challenging, especially in resource-limited settings. MR or transient elastography and many patented serum scores are costly and not widely available. There are limited data on accuracy of serum-based fibrosis scores in urban slum-dwelling population, which is a unique group due to its dietary habits and socioeconomic environment. We did this study to compare the accuracy of serum-based fibrosis scores to rule out significant fibrosis (SF) in this population.MethodsHistological and clinical data of 100 consecutive urban slum-dwelling patients with NAFLD were analysed. Institutional ethics committee permission was taken. Aspartate transaminase (AST) to platelet ratio index (APRI), fibrosis-4 index (FIB-4) and FIB-5 scores were compared among those with non-significant fibrosis (METAVIR; F0 to F1; n=73) and SF (METAVIR; F2 to F4; n=27).ResultsAST (IU/mL) (68.3±45.2 vs 23.9±10.9; p<0.0001), alanine transaminase (IU/mL) (76.4±36.8 vs 27.9±11.4; p<0.0001), FIB-4 (2.40±2.13 vs 0.85±0.52; p<0.0001) and APRI (1.18±0.92 vs 0.25±0.16; p<0.0001) were higher and platelets (100 000/mm3) (1.8±0.8 vs 2.6±0.7; p<0.0001), albumin (g/dL) (3.4±0.50 vs 3.7±0.4; p<0.0001), alkaline phosphatase (IU/L) (60.9±10.2 vs 76.4±12.9; p<0.0001) and FIB-5 (−1.10±6.58 vs 3.79±4.25; p<0.0001) were lower in SF group. APRI had the best accuracy (area under the receiver operating characteristic curve=0.95) followed by FIB-4 (0.78) and FIB-5 (0.75) in ruling out SF.ConclusionsAPRI but not FIB-5 or FIB-4 is accurate in ruling out SF in patients with NAFLD in an urban slum-dwelling population.

Evaluation of NAFLD and fibrosis in obese patients – a comparison of histological and clinical scoring systems

“…In this study, APRI proved vastly superior in diagnosing NASH and fibrosis in obese patients and performed better than Fib-4 and NAFLD fibrosis score. These findings concur with other studies, in which APRI also reached a higher accuracy than Fib-4 and NAFLD fibrosis score [ 32 , 33 ]. APRI furthermore has the obvious advantage to be easily assessable and moderate in costs.…”

“…APRI furthermore has the obvious advantage to be easily assessable and moderate in costs. It therefore could also be successfully applied in a low-income population [33].…”

Assessment of hepatic fibrosis and steatosis by vibration-controlled transient elastography and controlled attenuation parameter versus non-invasive assessment scores in patients with non-alcoholic fatty liver disease

“…Our results show that the best cut-off value for fibrosis detection by TE (LSM) vs. APRI score is 4.5 KPa, which fulfills the highest sensitivity, specificity, and accuracy (Table 4). This agrees with Kolhe et al who analyzed histological and clinical data of 100 consecutive urban slum-dwelling patients with NAFLD and showed that APRI had sensitivity, specificity, accuracy, PPV, NPV, and AUROC of 85.2%, 87.7%, 95%, 58.33%, 96.05%, and 0.95, respectively, with a statistically high significant correlation between APRI and biopsy-proven fibrosis [29].…”

Fibrosis-5 predicts end-stage renal disease in patients with microscopic polyangiitis and granulomatosis with polyangiitis without substantial liver diseases

“…The distinctive features of FIB-5, which is different from FIB-4, are inclusion of two variables (serum albumin and alkaline phosphatase [ALP]) and lower values are associated with a higher degree of fibrosis [ 8 ]. A previous study has reported that FIB-5 reflects the extent of liver fibrosis better than FIB-4 [ 9 ].…”