Accuracy of gamma-glutamyl transpeptidase-to-platelet ratio (GPR), red cell distribution width (RDW), aspartate aminotransferase-to-platelet ratio index (APRI), and the fibrosis-4 index (FIB4) compared with liver biopsy in patients with drug-induced liver injury (DILI)

Abstract

This study objected to evaluate the accuracy of the gamma-glutamyl transpeptidase-to-platelet ratio (GPR), aspartate aminotransferase-to-platelet ratio index (APRI), red cell distribution width (RDW), and fibrosis-4 index (FIB4) index, compared with liver biopsy (LB), in predicting the severity of inflammation in drug-induced liver injury (DILI) patients. We evaluated patients with DILI who were followed at the First Hospital of Jilin University and underwent LB. Accuracy of each method was analyzed using ROC analysis. Classifications of liver inflammation included G0–4. One hundred fifty six DILI patients were included with LB and complete medical records. 62.8% (98), 39.1% (61), and 16.7% (26) were classified as ≥G2, ≥G3, or G4, respectively. The AUROCs, by degree of inflammation, were: ≥G2: GPR: 0.654, RDW: 0.635, APRI: 0.728, and FIB4: 0.739; ≥G3: GPR: 0.623, RDW: 0.703, APRI: 0.777, and FIB4: 0.781; and G4: GPR: 0.556, RDW: 0.647, APRI: 0.729, and FIB4: 0.714. To predict ≥G2 inflammation, there were no differences between the AUROCs for GPR, RDW, APRI, and FIB4. To predict ≥G3 inflammation, the AUROCs for FIB4 and APRI were higher than that for GPR (0.781 vs 0.623, P < .01; 0.777 vs 0.623, P < .05). As for G4 inflammation, the AUROCs for FIB4 and APRI were also higher than GPR (0.714 vs 0.556, P < .05, 0.729 vs 0.556, P < .05). When the level of inflammation was higher than G2 in patients with DILI, it could be predicted using APRI and FIB4 as non-invasive markers for this condition.

Hepatic Impairment as a Risk Factor for Drug Safety: Suitability and Comparison of Four Liver Scores as Screening Tools

“…In fact, all scores have been developed for special hepatic patient groups [27][28][29]55,56], which might lead to the under-or overestimation of the clinical status of a patient when applying the scores for other etiologies. However, the use of these scores in different settings has been tested by others [30][31][32][33]57].…”

“…The actual AST, upper limit of normal of AST and platelet count are required for the calculation [29]. Beside the validated application areas, NFS, FIB-4, and APRI were tested as predictive models for the occurrence of cirrhosis in the general population [30], esophageal varices in hepatocellular carcinoma (HCC) patients [31], as well as mortality among COVID-19 patients [32] or inflammation in drug-induced liver injury [33].…”

Liver Fibrosis: Therapeutic Targets and Advances in Drug Therapy

“…Therefore, liver fibrosis caused by these chronic diseases is treated or even reversed because of the cure of these chronic diseases, that is, the removal of the cause. In addition, autoimmune hepatitis (AIH), drug-induced liver injury (DILI), non-alcoholic steatohepatitis (NASH), and alcoholic steatohepatitis (ASH) are also the main causes of liver fibrosis ( Mueller et al, 2010 ; Valera et al, 2011 ; Tacke and Weiskirchen, 2021 ; Wan et al, 2021 ). It has been reported that fibrosis and histological activity index of 54 AIH patients with liver fibrosis who received immunosuppressive therapy decreased significantly ( Valera et al, 2011 ).…”

İkinci-Üçüncü Trimesterde Aspartat Aminotransferaz Trombosit Oranı İndeksinin Gebeliğin İntrahepatik Kolestazı Öngörmesi ve İndeksin Yenidoğan Yoğun Bakım Gereksinimi ile İlişkisi: Üçüncü Basamak Bir Hastaneden Vaka Kontrol Çalışması

“…Aspartate aminotransferase (AST) -platelet ratio index (APRI) has been used in many studies to diagnose liver injury (5). Although the APRI score has been found to be a reliable predictor of fibrosis in previous studies (6), it remains unclear whether it is also a strong predictor for ICP.…”