Published online Dec 14, 2015. doi: 10.3748/wjg.v21.i46.13132
Peer-review started: July 4, 2015
First decision: July 19, 2015
Revised: August 4, 2015
Accepted: September 14, 2015
Article in press: September 15, 2015
Published online: December 14, 2015
AIM: To assess the diagnostic accuracy, of aminotransferase-to-platelet ratio index (APRI) alone and with antischistosomal antibody (Ab) in patients with hepatitis C virus (HCV) and schistosomiasis coinfection.
METHODS: This retrospective study included medical records of three hundred and eighty three Egyptian men patients who had undergone percutaneous liver biopsy between January 2006 to April 2014 in tertiary care hospital in Qatar for diagnosis or monitoring purpose were selected. Data of patients > 18 years of age were included in the study. The values of HCV RNA titer and antischistosomal antibody titer were also taken into consideration. Patients were excluded from the study if they had any other concomitant chronic liver disease, including; history of previous antiviral or interferon therapy, immunosuppressive, therapy, chronic hepatitis B infection, human immunodeficiency virus co-infection, autoimmune hepatitis, decompensated liver disease, hepatocellular carcinoma, prior liver transplantation, and if no data about the liver biopsy present.
RESULTS: Median age of patients was 46 years. About 7.1% had no fibrosis, whereas 30.4%, 37.5%, 20.4%, and 4.6% had fibrosis of stage I, II, III, and IV respectively. In bivariate analysis, APRI score, levels of AST, platelet count and age of patient showed statistically significant association with liver fibrosis (P < 0.0001); whereas antischistosomal antibody titer (P = 0.52) and HCV RNA titer (P = 0.79) failed to show a significant association. The respective AUC values for no fibrosis, significant fibrosis, severe fibrosis and cirrhosis of APRI score were 63%, 73.2%, 81.1% and 88.9% respectively. This showed good sensitivity and specificity of APRI alone for grading of liver fibrosis. But the inclusion of anti-Schistosoma antibody did not improve the prediction of fibrosis stage.
CONCLUSION: The study results suggest that noninvasive biochemical markers like APRI are sensitive and specific in diagnosing the degree of fibrosis and cirrhosis in patients with coinfection of HCV and schistosomiasis as compared to biopsy. The addition of antischistosomal Ab to APRI did not improve sensitivity for predicting the degree of cirrhosis.
Core tip: In few parts of the world, in addition to hepatitis C virus (HCV) other concomitant infections play a significant role in causing liver fibrosis. This study was conducted using data from 383 patients to evaluate accuracy of noninvasive method called aspartate transaminase to platelet ratio index (APRI). Its usefulness was explored for assessment of liver fibrosis. Also the role of anti-schistosomial antibody was evaluated for improving sensitivity and specificity of APRI. The APRI when used alone showed good sensitivity and specificity for accurately evaluating liver fibrosis in patients with HCV and schistosomiasis coinfection. The addition of antischistosomal antibody or HCV-RNA Titer, did not further improve the accuracy of APRI.