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- Title
Serum Fibrosis Marker Panels FIB-4 Index and Aspartate Aminotransferase (AST)-to-Platelet Ratio Index (APRI) Are Equivalent to AST Alone at Predicting Liver Fibrosis in a Cohort of 1731 Patients Infected with Hepatitis C Virus.
- Authors
Drees, Julia C.; Wi, Soora; Ready, Joanna B.; Dlott, Richard S.; Fetterman, Barbara J.; Seo, Suk I.; Pauly, Mary Pat; Petrie, Matthew S.; Lorey, Thomas S.
- Abstract
Background: Efficient tools are needed to stage liver disease before treatment of patients infected with hepatitis C virus (HCV). Compared to biopsy, several studies demonstrated favorable performance of noninvasive multianalyte serum fibrosis marker panels [fibrosis-4 (FIB-4) index] and aspartate aminotransferase (AST)-to-platelet ratio index (APRI), but suggested cutoffs vary widely. Ourobjective was to evaluate FIB-4 index and APRI and their component tests for staging fibrosis in our HCV-infected population and to determine practical cutoffs to help triage an influx of patients requiring treatment. Methods: Transient elastography (TE) results from 1731 HCV-infected patients were mapped to an F0-F4 equivalent scale. Each patient's APRI and FIB-4 index were calculated. Areas under the receiver operator curve (AUROCs) and false positive and false-negative rates were calculated to retrospectively compare the performance of the indices and their component tests. Results: The highest AUROCs for distinguishing severe (F3-F4) from mild-to-moderate (F0 -F2) fibrosis had overlapping 95% CIs: APRI (0.77; 0.74-0.79), FIB-4 index (0.76; 0.73-0.78), and AST (0.74; 0.72-0.77). Cutoffs had false negative rates of 2.7%-2.8% and false-positive rates of 6.4%-7.4% for all 3 markers. Conclusions: AST was as effective as FIB-4 index and APRI at predicting fibrosis. Published cutoffs for APRI and FIB-4 index would have been inappropriate in our population, with false-negative rates as high as 11%. For our purposes, no serum fibrosis marker was sufficiently sensitive to rule-out significant fibrosis, but cutoffs developed for AST, FIB-4 index, and APRI all had specificities of 79.2%-80.3% for ruling-in severe fibrosis and could be used to triage 1/3 of our population for treatment without waiting for TE or liver biopsy.
- Subjects
HEPATITIS C treatment; HEPATIC fibrosis; SERUM; ASPARTATE aminotransferase; ELASTOGRAPHY; LIVER biopsy
- Publication
Journal of Applied Laboratory Medicine, 2017, p76
- ISSN
2475-7241
- Publication type
Article
- DOI
10.1373/jalm.2016.022509