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Does Incorporating Change in APRI or FIB-4 Indices Over Time Improve the Accuracy of a Single Index for Identifying Liver Fibrosis in Persons With Chronic Hepatitis C Virus Infection?

Gounder, Prabhu P. et al.

Journal of clinical gastroenterology. Volume 52:Issue 1 (2018); pp 60-66 -- Wolters Kluwer

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  • Title:
    Does Incorporating Change in APRI or FIB-4 Indices Over Time Improve the Accuracy of a Single Index for Identifying Liver Fibrosis in Persons With Chronic Hepatitis C Virus Infection?
  • Author: Gounder, Prabhu P.;
    Haering, Celia;
    Bruden, Dana J. T.;
    Townshend-Bulson, Lisa;
    Simons, Brenna C.;
    Spradling, Philip R.;
    McMahon, Brian J.
  • Found In: Journal of clinical gastroenterology. Volume 52:Issue 1 (2018); pp 60-66
  • Journal Title: Journal of clinical gastroenterology
  • Subjects: Periodicals; Digestive organs--Diseases--Periodicals; Gastroenterology--Periodicals; Digestive organs--Diseases; Gastroenterology; diagnosis--cirrhosis--viral hepatitis--epidemiologic study; Dewey: 616.33005
  • Rights: Licensed
  • Publication Details: Wolters Kluwer
  • Abstract: Background:

    The aspartate aminotransferase-to-platelet ratio index (APRI) and a fibrosis index calculated using platelets (FIB-4) have been proposed as noninvasive markers of liver fibrosis.

    Goals:

    To determine APRI/FIB-4 accuracy for predicting histologic liver fibrosis and evaluate whether incorporating change in index improves test accuracy in hepatitis C virus (HCV)-infected Alaska Native persons.

    Study:

    Using liver histology as the gold standard, we determined the test characteristics of APRI to predict Metavir ≥F2 fibrosis and FIB-4 to predict Metavir ≥F3 fibrosis. Index discrimination was measured as the area under the receiver operator characteristic curve. We fit a logistic regression model to determine whether incorporating change in APRI/FIB-4 over time improved index discrimination.

    Results:

    Among 283 participants, 46% were female, 48% had a body mass index >30, 11% had diabetes mellitus, 8% reported current heavy alcohol use. Participants were infected with HCV genotypes 1 (68%), 2 (17%), or 3 (15%). On liver histology, 30% of study participants had ≥F2 fibrosis and 15% had ≥F3 fibrosis. The positive predictive value of an APRI>1.5/FIB-4>3.25 for identifying fibrosis was 77%/78%. The negative predictive value of an APRI<0.5/FIB-4<1.45 was 91%/87%. The area under the receiver operator characteristic curve of an APRI/FIB-4 for identifying fibrosis was 0.82/0.84. Incorporating change in APRI/FIB-4 did not improve index discrimination.

    Conclusions:

    The accuracy of APRI/FIB-4 for identifying liver fibrosis in HCV-infected Alaska Native persons is similar to that reported in other populations and could help prioritize patients for treatment living in areas without access to liver biopsy. Change in APRI/FIB-4 was not predictive of degree of fibrosis.


  • Identifier: System Number: ETOCvdc_100055296432.0x000001; Journal ISSN: 0192-0790; doi/10.1097/MCG.0000000000000753
  • Publication Date: 2018
  • Physical Description: Electronic
  • Shelfmark(s): 4958.470000
  • UIN: ETOCvdc_100055296432.0x000001

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