Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 18, 2017; 9(17): 791-796
Published online Jun 18, 2017. doi: 10.4254/wjh.v9.i17.791
Use of aspartate aminotransferase to platelet ratio to reduce the need for FibroScan in the evaluation of liver fibrosis
Stephanie Wong, Dep Huynh, Frank Zhang, Nam Q Nguyen
Stephanie Wong, Dep Huynh, Frank Zhang, Nam Q Nguyen, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, Australia
Dep Huynh, Frank Zhang, Nam Q Nguyen, Discipline of Medicine, University of Adelaide, Adelaide 5000, Australia
Author contributions: Wong S contributed to data acquisition, analysis of data, drafting of manuscript; Huynh D contributed to analysis of data, critical revisions to manuscript; Zhang F contributed to data acquisition and analysis of data; Nguyen NQ contributed to study concept and design, analysis of data, critical revisions to manuscript.
Institutional review board statement: The study was reviewed and approved by the Royal Adelaide Hospital Human Research Ethics Committee.
Informed consent statement: The need to obtain informed consent from subjects was waived by the Royal Adelaide Research Ethics Committee.
Conflict-of-interest statement: No conflict of interest to disclose from all authors.
Data sharing statement: No additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nam Q Nguyen, Associate Professor, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, North Terrace, Adelaide 5000, Australia. quocnam.nguyen@sa.gov.au
Telephone: +61-8-82224000 Fax: +61-8-82225885
Received: December 28, 2016
Peer-review started: December 29, 2016
First decision: February 4, 2017
Revised: March 6, 2017
Accepted: April 23, 2017
Article in press: April 24, 2017
Published online: June 18, 2017
Abstract
AIM

To evaluate the performance of aspartate aminotransferase to platelet ratio (APRI) score against FibroScan in predicting the presence of fibrosis.

METHODS

Data of patients who concurrently had APRI score, FibroScan and liver biopsy to assess their hepatitis C virus (HCV) and hepatitis B virus (HBV) over 6 years were retrospectively reviewed and details of their disease characteristics and demographics were recorded. Advanced fibrosis was defined as ≥ F3.

RESULTS

Of the 3619 patients (47.5 ± 11.3 years, 97M:36F) who had FibroScans and APRI for HCV and HBV, 133 had concurrent liver biopsy. Advanced liver fibrosis was found in 27/133 (20%, F3 = 21 and F4 = 6) patients. Although APRI score (P < 0.001, AUC = 0.83) and FibroScan (P < 0.001, AUC = 0.84) predicted the presence of advanced fibrosis, the sensitivities and specificities were only modest (APRI score: 51.9% sensitivity, 84.9% specificity; FibroScan: 63% sensitivity, 84% specificity). Whilst 13/27 (48%) patients with advanced fibrosis had APRI ≤ 1.0, no patients with APRI ≤ 0.5 had advanced fibrosis, with 100% sensitivity. The use of APRI ≤ 0.5 would avoid the need for FibroScan in 43% of patients.

CONCLUSION

APRI score and FibroScan performed equally well in predicting advanced fibrosis. A proposed APRI cut-off score of 0.5 could be used as a screening tool for FibroScan, as cut-off score of 1.0 will miss up to 48% of patients with advanced fibrosis. Further prospective validation studies are required to confirm this finding.

Keywords: Liver fibrosis, Aspartate aminotransferase to platelet ratio, Utilization, FibroScan

Core tip: This is the first study to show that an aspartate aminotransferase to platelet ratio (APRI) score of 0.5 could potentially be used as a screening tool to predict the need for FibroScan in patients with hepatitis C or hepatitis B. Our study showed that an APRI score of 0.5 could reduce the need for FibroScan in 43% of the study cohort with high sensitivity.