Can aspartate aminotransferase to platelet ratio index replace liver biopsy in chronic hepatitis C.
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Date
2011-10
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Abstract
Background and aim: We aimed to evaluate the accuracy of readily available laboratory tests (ALT, AST, platelet count, AST to platelet ratio index: APRI) in predicting liver fibrosis in
chronic hepatitis C, in comparison to the predictive accuracy obtained by liver biopsy.
Methods: One hundred and thirteen patients suffering from chronic hepatitis C (CHC) were
included in this study. They included 76 children enrolled from the Pediatric Hepatology Unit
and 37 adults enrolled from the Hepatology Unit of Tropical Medicine Department, Cairo
University, Egypt. Fibrosis results obtained from liver biopsy were assigned a score from 0 to
4 score as per Metavir scoring. Results of serum ALT and AST levels were expressed as ratio
of the upper limit of normal (ULN).
Results: Of the pediatric patients, 28 (36.8%) showed no evidence of fibrosis on liver biopsy,
26 (34.2%) showed grade 1 fibrosis, and 22 (29%) had grade 2 fibrosis. Among the adult
patients, 12 (32.4%) had grade 2 fibrosis and 25 patients (67.6%) had grades 3 to 4 fibrosis.
There was a lack of correlation between the degree of fibrosis and AST levels, AST/ALT ratio,
platelet count and APRI. The AUROC curve for predicting significant fibrosis was 0.5 for AST
levels, 0.37 for AST/ALT ratio and 0.49 for APRI, in pediatric patients (p >0.05). In adult
patients the AUROC curve for predicting significant fibrosis was 0.59 for AST levels, 0.76 for
AST/ALT ratio and 0.63 for APRI (p >0.05).
Conclusion: Liver biopsy remains the gold standard to assess the extent of hepatic fibrosis in patients with CHC.
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Keywords
Hepatitis C, liver fibrosis, non-invasive tests of liver fibrosis, APRI
Citation
El-Sayed Rokaya, Fahmy Mona, Koofy Nehal El, El- Raziky Mona, El-Hawary Manal, Helmy Heba, El-Akel Wafaa, El-Hennawy Ahmad, El-Karaksy Hanaa. Can aspartate aminotransferase to platelet ratio index replace liver biopsy in chronic hepatitis C. Tropical Gastroenterology. 2011 Oct-Dec; 32(4): 267-272.