Published online Jun 18, 2017. doi: 10.4254/wjh.v9.i17.791
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
Processing time: 167 Days and 18.8 Hours
To evaluate the performance of aspartate aminotransferase to platelet ratio (APRI) score against FibroScan in predicting the presence of fibrosis.
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.
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.
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.
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.