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- Title
Aspartate aminotransferase to platelet ratio index as a prospective predictor of hepatocellular carcinoma risk in patients with chronic hepatitis B virus infection.
- Authors
Hann, Hie‐Won; Wan, Shaogui; Lai, Yinzhi; Hann, Richard S; Myers, Ronald E; Patel, Fenil; Zhang, Kejin; Ye, Zhong; Wang, Chun; Yang, Hushan
- Abstract
Background and Aim APRI (aspartate aminotransferase [ AST] to platelet ratio index) is widely used to assess fibrosis and cirrhosis risk, especially in hepatitis C virus ( HCV)-infected patients. Few studies have evaluated APRI and hepatitis B virus ( HBV)-related hepatocellular carcinoma ( HCC) risk. Prospective evidence is needed to assess whether APRI predicts HCC risk in HBV patients. Method In a prospectively enrolled clinical cohort of 855 HBV patients with a 1-year exclusion window (followed for > 1 year and did not develop HCC within 1 year), the predictive value of APRI in HCC risk was evaluated by Cox proportional hazards model using univariate and multivariate analyses and longitudinal analysis. Results Higher APRI prospectively conferred a significantly increased risk of HCC in univariate analysis (quartile analysis, P trend = 2.9 × 10−7). This effect remained highly significant after adjusting for common host characteristics but not cirrhosis ( P trend = 7.1 × 10−5), and attenuated when cirrhosis is adjusted ( P trend = 0.021). The effect remained prominent when the analysis was restricted to patients with a more stringent 2-year exclusion window ( P trend = 0.008 in quartile analysis adjusting all characteristics including cirrhosis), indicating that the association was unlikely due to including undetected HCC patients in the cohort, thus minimizing the reverse-causation limitation in most retrospective studies. Longitudinal comparison demonstrated a persistently higher APRI value in HBV patients who developed HCC during follow-up than those remaining cancer free. Conclusion APRI might be a marker of HCC risk in HBV patients in cirrhosis-dependent and -independent manners. Further studies are warranted to validate this finding and test its clinical applicability in HCC prevention.
- Subjects
HEPATITIS B virus; CANCER risk factors; LIVER cancer; ASPARTATE aminotransferase; CIRRHOSIS of the liver; PROPORTIONAL hazards models; MULTIVARIATE analysis; UNIVARIATE analysis
- Publication
Journal of Gastroenterology & Hepatology, 2015, Vol 30, Issue 1, p131
- ISSN
0815-9319
- Publication type
Article
- DOI
10.1111/jgh.12664