Assessment of liver fibrosis progression in patients with chronic hepatitis C and normal alanine aminotransferase values: The role of AST to the platelet ratio index

Fabris, Carlo; Smirne, Carlo; Toniutto, Pierluigi; Colletta, C.; Rapetti, Rachele; Minisini, Rosalba; Falleti, Edmondo; Pirisi, Mario

doi:10.1016/j.clinbiochem.2006.01.011

Cited by 29 publications

(25 citation statements)

References 27 publications

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“…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] and 0.82 [95%CI: 0.79-0.86], respectively; an APRI threshold of 0.5 was 81% sensitive and 50% specific, at a 40% prevalence of significant fibrosis, this threshold had a negative predictive value (NPV) of 80%.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis B-related fibrosis: a leading meta-analysis

et al. 2012

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BackgroundThe 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.MethodsAreas 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.ResultsNine 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.ConclusionOur meta-analysis suggests that APRI show limited value in identifying hepatitis B-related significant fibrosis and cirrhosis.

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Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis B-related fibrosis: a leading meta-analysis

et al. 2012

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“…Thirty-three studies examined the APRI in patients with chronic hepatitis C. Ultimately, 11 studies were excluded for duplication of data (n ϭ 1), 38 insufficient data (n ϭ 5), 11,[39][40][41][42] small sample size (n ϭ 2), 43,44 or failure to use biopsy as the reference test (n ϭ 3). [45][46][47] Thus, our final data set for the meta-analysis included 22 studies (Table 1).…”

Section: Search Resultsmentioning

confidence: 99%

Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis C–related fibrosis: A systematic review

2007

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The development of noninvasive markers of liver fibrosis is a clinical and research priority. The aspartate aminotransferase-to-platelet ratio index (APRI) is a promising tool with limited expense and widespread availability. Our objective was to systematically review the performance of the APRI in hepatitis C virus (HCV)-infected patients. Random effects meta-analyses and areas under summary receiver operating characteristic curves (AUC) were examined to characterize APRI accuracy for significant fibrosis (stages 2-4) and cirrhosis. In 22 studies (n ‫؍‬ 4,266), the summary AUCs of the APRI for significant fibrosis and cirrhosis were 0.76 [95% confidence interval (CI), 0.74-0.79] and 0.82 (95%CI, 0.79-0.86), respectively. For significant fibrosis, an APRI threshold of 0.5 was 81% sensitive and 50% specific. At a 40% prevalence of significant fibrosis, this threshold had a negative predictive value (NPV) of 80%, but could reduce the necessity of liver biopsy by only 35%. For cirrhosis, a threshold of 1.0 was 76% sensitive and 71% specific. At a 15% cirrhosis prevalence, the NPV of this threshold was 91%. Higher APRI thresholds had suboptimal positive predictive values except in settings with a high prevalence of cirrhosis. APRI accuracy was not affected by the prevalence of advanced fibrosis, or study and biopsy quality. However, the accuracy for cirrhosis was greater in studies including human immunodeficiency virus (HIV)/HCV-co-infected patients. Conclusion: The major strength of the APRI is the exclusion of significant HCV-related fibrosis. Future studies of novel markers should demonstrate improved accuracy and cost-effectiveness compared with this economical and widely available index. (HEPATOLOGY 2007;46:912-921.)

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“…To determine the non-alcoholic steatohepatitis, and prognose of disease liver biopsy is the only reliable diagnostic tool [6][7][8], but the role of liver biopsy in NA-FLD is controversial, due to the benign course of disease in most cases, the lack of established effective therapies, complications such as pain, rupture, bleeding, and death, sampling error, intra-and interpathologist evaluation variability, and its high cost [6,9]. However, noninvasive diagnostic tests and indexes, such as AciTest, FibroTest, aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, age-platelet index, and AST to platelet ratio [10], have been recently focused on to replace the biopsy.…”

Section: Introductionmentioning

confidence: 98%

Diagnostic Value of Serum Prolidase Enzyme Activity to Predict the Liver Histological Lesions in Non-alcoholic Fatty Liver Disease: A Surrogate Marker to Distinguish Steatohepatitis from Simple Steatosis

et al. 2008

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Determination of the liver histological lesions with noninvasive tests is an important part of the diagnostic work-up of patients with non-alcoholic fatty liver disease (NAFLD). We aimed to determine the predictive value of noninvasive biochemical markers, serum prolidase enzyme activity (SPEA), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and AST/ALT ratio for the liver histological lesions. Fifty-four liver biopsy-proven patients with NAFLD and 37 healthy controls were enrolled to the study. The diagnostic accuracies of biochemical markers were evaluated by receiver operating characteristic (ROC) curves and multiple linear regression analysis to predict the degree of fatty infiltration, lobular inflammation, NAFLD activity score, and stage of fibrosis. The SPEA of patients with steatohepatitis is significantly increased compared with the patients with simple steatosis and controls (1,338 [1,138-1,624] U/l; 974 [768-1,160] U/l; 972 [862-1,122] U/l, shown as median [25th-75th interquartile range], respectively, P < 0.0001). SPEA was positively correlated with the grade of liver fatty infiltration, lobular inflammation and NAFLD activity score, and stage of fibrosis, (r = 0.377, P < 0.005; r = 0.443, P < 0.001; r = 0.457, P < 0.001; r = 0.321, P < 0.018, respectively). SPEA was the best predictor for distinguishing steatohepatitis from simple steatosis according to the ROC analysis (area under the curve [AUC]: 0.85). Multivariate analysis revealed that the most useful single test for predicting lobular inflammation, NAFLD activity score, and fibrosis was SPEA, and for predicting the fatty infiltration, it was ALT (P < 0.00001, P < 0.001, P < 0.0001, P < 0.0001, respectively). This study demonstrated that SPEA can accurately predict the degree and stage of all histological lesions in NAFLD. It could be helpful for distinguishing steatohepatitis from simple steatosis and reducing the need for liver biopsy in the majority of patients with NAFLD.

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Assessment of liver fibrosis progression in patients with chronic hepatitis C and normal alanine aminotransferase values: The role of AST to the platelet ratio index

Cited by 29 publications

References 27 publications

Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis B-related fibrosis: a leading meta-analysis

Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis B-related fibrosis: a leading meta-analysis

Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis C–related fibrosis: A systematic review

Diagnostic Value of Serum Prolidase Enzyme Activity to Predict the Liver Histological Lesions in Non-alcoholic Fatty Liver Disease: A Surrogate Marker to Distinguish Steatohepatitis from Simple Steatosis

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