Is apri score a suitable tool for prediction of fibrosis in tunisian patients with genotype 1 chronic viral hepatitis c?
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Abstract
Background: Therapeutic indications in chronic genotype 1 hepatitis C are based on severity of fibrosis. APRI score is a simple, cheap and reproducible biochemical test. Performances of APRI score in Tunisian population with chronic hepatitis C were not previously prospectively studied.
Aim: To evaluate the performances of APRI score in prediction of severity of fibrosis in chronic genotype 1 hepatitis C based on a prospective study.
Methods:We prospectively include patients with chronic genotype 1 hepatitis C and positive viral load. Hepatic biopsy was performed in all included patients and abnormalities were classified according to METAVIR classification. In all patients, APRI score was calculated based on biochemical data collected within the 15 days before hepatic biopsy.
Results: We studied 140 patients (46 men, mean age 48.4 years (20 – 65 years)). Mean APRI score was 0.89 (0.18 – 3.72). Statistically significant correlation was observed between APRI score and fibrosis severity (r = 0.31 p < 0.0001). APRI score was higher in patients with severe fibrosis (F2, F3 or F4) compared to patients with moderate fibrosis (F0 or F1) (0.97 + 0.68 vs 0.62 + 0.44; p 0.009). Threshold value of APRI score of 0.72 was associated with area under the curve of 0.65 + 0.05 (0.57 – 0.73), sensitivity of 56.3% and specificity of 75.8% in prediction of severe fibrosis. APRI score was also higher in patients with cirrhosis (1.24 + 0.79 vs 0.85 + 0.61; p = 0.01). Threshold value of 0.86 was associated with area under the curve of 0.69 + 0.07 (0.61 – 0.77), sensitivity of 76.4% and specificity of 65.8% in prediction of cirrhosis.
Conclusion: APRI score is not a good alternative to hepatic biopsy although a strong correlation with fibrosis severity, because of relatively low area under the curve, sensitivity and specificity in prediction of severe fibrosis and cirrhosis.
Aim: To evaluate the performances of APRI score in prediction of severity of fibrosis in chronic genotype 1 hepatitis C based on a prospective study.
Methods:We prospectively include patients with chronic genotype 1 hepatitis C and positive viral load. Hepatic biopsy was performed in all included patients and abnormalities were classified according to METAVIR classification. In all patients, APRI score was calculated based on biochemical data collected within the 15 days before hepatic biopsy.
Results: We studied 140 patients (46 men, mean age 48.4 years (20 – 65 years)). Mean APRI score was 0.89 (0.18 – 3.72). Statistically significant correlation was observed between APRI score and fibrosis severity (r = 0.31 p < 0.0001). APRI score was higher in patients with severe fibrosis (F2, F3 or F4) compared to patients with moderate fibrosis (F0 or F1) (0.97 + 0.68 vs 0.62 + 0.44; p 0.009). Threshold value of APRI score of 0.72 was associated with area under the curve of 0.65 + 0.05 (0.57 – 0.73), sensitivity of 56.3% and specificity of 75.8% in prediction of severe fibrosis. APRI score was also higher in patients with cirrhosis (1.24 + 0.79 vs 0.85 + 0.61; p = 0.01). Threshold value of 0.86 was associated with area under the curve of 0.69 + 0.07 (0.61 – 0.77), sensitivity of 76.4% and specificity of 65.8% in prediction of cirrhosis.
Conclusion: APRI score is not a good alternative to hepatic biopsy although a strong correlation with fibrosis severity, because of relatively low area under the curve, sensitivity and specificity in prediction of severe fibrosis and cirrhosis.
Keywords:
APRI score - Chronic viral hepatitis C - Fibrosis##plugins.themes.academic_pro.article.details##
References
- Heathcote J, Main J. Treatment of hepatitis C. J Viral Hep 2005; 12: 223-35.
- Nousbaun JP. Place de la biopsie hépatique dans la prise en charge de l'hépatite chronique C. Gastroenterol Clin Biol 2002;26:B126-B179.
- Smith JP, Sterling RK. Systematic review: Non-invasive methods of fibrosis analysis in chronic hepatitis C. Aliment Pharmacol Ther 2009; 30: 557-76.
- Leroy V, Halfon P, Bacq Y et al. Diagnostic accuracy, reproductibility and robustness of fibrosis blood tests in chronic hepatitis C: A meta-analysis with individual data. Clin Biochem 2008;41: 1368-76.
- Iacobellis A, Mangia A, Leandro G et al. External validation of biochemical indices for non invasive evaluation of liver fibrosis in chronic hepatitis. Am J Gastroenterol 2005;100: 868-73.
- Kawamoto M, Mizuguchi T, Katsuramari T et al. Assessment of liver fibrosis by a non-invasive method of transient elastography and biochemical markers. World J Gastroenterol 2006;12:4325- 30.
- Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. The French METAVIR Cooperative Study Group. Hepatology 1994; 20: 15-20.
- Karoui S, Jomni MT, Bellil K, Haouet S, Boubaker J, Filali A. Facteurs prédictifs de fibrose au cours de l'hépatite chronique virale C. Tunis Med 2007 ;85 :454-60.
- Mejri S, Ben Salah A, Triki H et al. Contrasting patterns of hepatitis C virus infection in two regions from Tunisia. J Med Virol 2005;76: 185-93.
- Trinchet JC. Pourquoi et comment évaluer la fibrose hépatique en 2007? Gastroenterol Clin Biol 2007 ;31 :501-3.
- Wai CT, Greenson JK, Fontana RJ et al. A simple non-invasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003;38:518-26.
- Shaheen AA, Myers RP. Diagnostic accuracy of the Aspartate Aminotransferase-To Platelet Ratio Index for the prediction of chronic hepatitis C related cirrhosis. A systematic review. Hepatology 2007; 46:912-21.
- Carvalho-Filho RJ, Schiavon LL, Narciso-Schiavon JL et al. Optimized cutoffs improve performance of the aspartate aminotranferase to platelet ratio index for predicting significant liver fibrosis in human immunodeficiency virus/hepatitis C virus coinfection. Liver Int 2008;28:486-93.
- Calès P, de Ledinghen V, Halfon P et al. Evaluating the accuracy and increasing the reliable diagnosis rate of blood tests for liver fibrosis in chronic hepatitis C. Liver Int 2008;28:1352-62.
- Shin WG, Park SH, Jang MK et al. Aspartate Aminotransferase- To Platelet Ratio Index (APRI) can predict liver fibrosis in chronic hepatitis B. Dig Liver Dis 2008;40:267-74.