Need for validation of clinical decision aids: use of the AST/ALT ratio in predicting cirrhosis in chronic hepatitis C

Imperiale, Thomas F.; Said, Areen; Cummings, Oscar W.; Born, Lawrence J.

doi:10.1111/j.1572-0241.2000.02322.x

Cited by 96 publications

(36 citation statements)

References 21 publications

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“…35,36 In conclusion, advanced age, elevated serum GGT and AST levels, prolonged prothrombin time and the presence of splenomegaly are independent variables determining severe liver fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Liver Fibrosis in Patients with Chronic HCV Infection

Ceylan¹,

Yardimci²,

Fincancı³

et al. 2012

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The aim of this study was to investigate the independent variables for the degree of liver fibrosis in patients with chronic hepatitis C virus (HCV) infection. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : In this cross-sectional retrospective study, the patients were divided in two groups as Group A (patients with fibrosis score 0-2) and Group B (patients with fibrosis score 3-4) and they were compared in terms of age, gender, body mass index, alcohol consumption, presence of diabetes, serum HCV RNA, alanine aminotransferase, gamma-glutamyl transferase, and aspartate aminotransferase, total bilirubin, albumin, globulin and alkaline phosphatase levels, prothrombin time, blood thrombocyte count, splenomegaly in ultrasonographic examination, HCV genotype and liver steatosis. R Re es su ul lt ts s: : Of 201 patients, 93 (46.3%) were males; the median age was 51 (range: 18-77) years. It was found that serum gamma-glutamyl transferase and aspartate aminotransferase levels, age, prothrombin time and the presence of splenomegaly were independent variables predictive of advanced liver fibrosis. Odds ratio and p values were 1.984 and 0.013 for gamma-glutamyl transferase, 1.633 and 0.018 for aspartate aminotransferase, 1.861 and 0.003 for age, 5.598 and 0.008 for splenomegaly and 0.541 and 0.007 for prothrombin time, respectively. C Co on nc cl lu us si io on n: : The results of this study suggested that advanced age, elevated serum gamma-glutamyl transferase and, aspartate aminotransferase levels, prolonged prothrombin time and the presence of splenomegaly are independent variables determining severe liver fibrosis. K Ke ey y W Wo or rd ds s: : Liver cirrhosis; hepacivirus Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmanın amacı kronik hepatit C virüsü (HCV) enfeksiyonlu olgularda karaciğer fibrozunun derecesini belirleyen bağımsız değişkenleri araştırmaktı. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Bu geriye dönük kesitsel çalışmada hastalar Grup A (fibroz skoru 0-2 olanlar) ve Grup B (fibroz skoru 3-4 olanlar) olarak iki gruba ayrıldı ve gruplar yaş, cinsiyet, beden kitle indeksi, alkol kullanımı, diyabet varlığı, serum HCV RNA, alanin aminotransferaz, gama-glutamil transferaz, aspartat aminotransferaz, total bilirubin, albumin, globulin ve alkalen fosfataz seviyeleri, protrombin zamanı, kan trombosit sayısı, ultrasonografide splenomegali varlığı, HCV genotip ve karaciğer yağlanması açısın-dan karşılaştırıldı. B Bu ul lg gu ul la ar r: : İkiyüz bir hastadan 93 (%46,3)'ü erkekti ve ortanca yaş 51 (alt ve üst sınırlar: 18-77 yıl) idi. Serum gama-glutamil transferaz ve aspartat aminotransferaz düzeyleri, yaş, protrombin zamanı ve splenomegalinin ileri karaciğer fibrozunu belirleyen bağımsız değişkenler olduğu bulundu. Odds oranı ve p değerleri gamaglutamil transferaz için 1,984 ve 0,013; aspartat aminotransferaz için 1,633 ve 0,018; yaş için 1,861 ve 0,003; splenomegali için 5,598 ve 0,008 ve protrombin zamanı için 0,541 ve 0,007 idi. S So on nu uç ...

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Section: Discussionmentioning

confidence: 99%

Predictors of Liver Fibrosis in Patients with Chronic HCV Infection

Ceylan¹,

Yardimci²,

Fincancı³

et al. 2012

Turkiye Klinikleri J Med Sci

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“…''Indirect'' serum markers including simple routine blood tests, such as prothrombin index [19], platelet count [24], and AST/ALT ratio [25][26][27] have also been proposed.…”

Section: Biological Approach: Serum Fibrosis Biomarkersmentioning

confidence: 99%

Non-invasive assessment of liver fibrosis in chronic hepatitis C

Castéra

2011

Hepatol Int

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“…Several serum markers, and their combination in scores, have been reported as predicting the presence of cirrhosis with a high degree of accuracy. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] However, most of them have been evaluated only in patients infected with hepatitis C virus (HCV), and few have been validated. In addition, these markers could be influenced by extrahepatic conditions, and their overall diagnostic value for cirrhosis is less than optimal.…”

mentioning

confidence: 99%

Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases

et al. 2006

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A proper diagnosis of cirrhosis is essential for the management of patients with chronic liver diseases. We assessed the accuracy of liver stiffness measurement by Fibroscan for the diagnosis of cirrhosis in 1,257 patients with chronic liver diseases of various causes enrolled in a prospective multicenter study as well as clarified causes of discrepancies between liver histology and Fibroscan. One hundred thirty-two patients had unsuitable biopsy specimens, and 118 had unreliable liver stiffness measurements. Because 232 patients overlapped with a previous study, analysis was performed in the 775 new patients then derived in the whole population (1,007; 165 cirrhosis). Diagnostic accuracy was assessed by receiver operator curve (ROC) analysis. Liver samples were re-analyzed in case of discrepancies. The area under the ROC (AUROC) was 0.95 (95% CI, 0.93-0.96) for the diagnosis of cirrhosis in either 775 or 1,007 patients. The cutoff value with optimal diagnosis accuracy was 14.6 kPa in 1,007 patients (positive and negative predictive values, 74% and 96%) with discrepancies among the etiological groups. Eighty patients were misclassified: (1) among 45 patients without cirrhosis with liver stiffness 14.6 kPa or greater, 27 (60%) had extensive fibrosis and 10 (22%) significant perisinusoidal fibrosis; and (2) among 35 patients with cirrhosis and liver stiffness less than 14.6 kPa, 10 (29%) had a macronodular pattern and 25 (71%) either none or mild activity. In conclusion, Fibroscan is a reliable method for the diagnosis of cirrhosis in patients with chronic liver diseases, better at excluding than at predicting cirrhosis using a threshold of 14.6 kPa. False-negatives are mainly attributable to inactive or macronodular cirrhosis. (HEPATOLOGY 2006;44:1511-1517

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Need for validation of clinical decision aids: use of the AST/ALT ratio in predicting cirrhosis in chronic hepatitis C

Abstract: These results suggest that an AAR > or =1 may not be as useful for predicting cirrhosis in chronic hepatitis C as previously thought, and emphasizes the need for validation of clinical decision aids on independent patient cohorts.

Cited by 96 publications

References 21 publications

Predictors of Liver Fibrosis in Patients with Chronic HCV Infection

Predictors of Liver Fibrosis in Patients with Chronic HCV Infection

Non-invasive assessment of liver fibrosis in chronic hepatitis C

Accuracy of liver stiffness measurement for the diagnosis of cirrhosis in patients with chronic liver diseases

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