APRI: An Easy and Validated Predictor of Hepatic Fibrosis in Chronic Hepatitis C

Snyder, Ned; Gajula, Leka; Xiao, Shu Yuan; Grady, James J.; Luxon, Bruce A.; Lau, Daryl T.Y.; Soloway, Roger D.; Petersen, John R.

doi:10.1097/00004836-200607000-00013

Cited by 111 publications

(65 citation statements)

References 24 publications

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“…Of 47 different evaluated tests, only 18 converged with the bivariate random-effects model [APRI low and high cut-offs, AST-ALT ratio, FIB-4 low and high cut offs, Forns index low and high cut-off, Göteborg University Cirrhosis Index (GUCI), Lok's index, platelet count, hyaluronic acid, Hepascore, Fibrometer, Fibrotest standard, low and high cut-offs, platelet-to-spleen-diameter ratio and Fibroscan]. The most commonly evaluated non-invasive tests were APRI (low cut-off), which was evaluated in 47 studies, 24,31,73,74,79,81,84,85,89,90,91,94,97,98,103,107,109,121,126,127,130,131,134,137,140,143,144,146,150,[152][153][154][156][157][158]163,164,168,182,185,187,189,194,195,210,218,220,223 followed by TE in 37 studies 28,29,75,76,…”

Section: Results: Hepatitis C Virusmentioning

confidence: 99%

Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic review and economic evaluation

Crossan

Tsochatzis

Longworth

et al. 2015

Health Technology Assessment

147

190

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BackgroundLiver biopsy is the reference standard for diagnosing the extent of fibrosis in chronic liver disease; however, it is invasive, with the potential for serious complications. Alternatives to biopsy include non-invasive liver tests (NILTs); however, the cost-effectiveness of these needs to be established.ObjectiveTo assess the diagnostic accuracy and cost-effectiveness of NILTs in patients with chronic liver disease.Data sourcesWe searched various databases from 1998 to April 2012, recent conference proceedings and reference lists.MethodsWe included studies that assessed the diagnostic accuracy of NILTs using liver biopsy as the reference standard. Diagnostic studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Meta-analysis was conducted using the bivariate random-effects model with correlation between sensitivity and specificity (whenever possible). Decision models were used to evaluate the cost-effectiveness of the NILTs. Expected costs were estimated using a NHS perspective and health outcomes were measured as quality-adjusted life-years (QALYs). Markov models were developed to estimate long-term costs and QALYs following testing, and antiviral treatment where indicated, for chronic hepatitis B (HBV) and chronic hepatitis C (HCV). NILTs were compared with each other, sequential testing strategies, biopsy and strategies including no testing. For alcoholic liver disease (ALD), we assessed the cost-effectiveness of NILTs in the context of potentially increasing abstinence from alcohol. Owing to a lack of data and treatments specifically for fibrosis in patients with non-alcoholic fatty liver disease (NAFLD), the analysis was limited to an incremental cost per correct diagnosis. An analysis of NILTs to identify patients with cirrhosis for increased monitoring was also conducted.ResultsGiven a cost-effectiveness threshold of £20,000 per QALY, treating everyone with HCV without prior testing was cost-effective with an incremental cost-effectiveness ratio (ICER) of £9204. This was robust in most sensitivity analyses but sensitive to the extent of treatment benefit for patients with mild fibrosis. For HBV [hepatitis B e antigen (HBeAg)-negative)] this strategy had an ICER of £28,137, which was cost-effective only if the upper bound of the standard UK cost-effectiveness threshold range (£30,000) is acceptable. For HBeAg-positive disease, two NILTs applied sequentially (hyaluronic acid and magnetic resonance elastography) were cost-effective at a £20,000 threshold (ICER: £19,612); however, the results were highly uncertain, with several test strategies having similar expected outcomes and costs. For patients with ALD, liver biopsy was the cost-effective strategy, with an ICER of £822.LimitationsA substantial number of tests had only one study from which diagnostic accuracy was derived; therefore, there is a high risk of bias. Most NILTs did not have validated cut-offs for diagnosis of specific fibrosis stages. The findings of the ALD model were dependent on assuptions about abstinence rates assumptions and the modelling approach for NAFLD was hindered by the lack of evidence on clinically effective treatments.ConclusionsTreating everyone without NILTs is cost-effective for patients with HCV, but only for HBeAg-negative if the higher cost-effectiveness threshold is appropriate. For HBeAg-positive, two NILTs applied sequentially were cost-effective but highly uncertain. Further evidence for treatment effectiveness is required for ALD and NAFLD.Study registrationThis study is registered as PROSPERO CRD42011001561.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Results: Hepatitis C Virusmentioning

confidence: 99%

Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic review and economic evaluation

Crossan

Tsochatzis

Longworth

et al. 2015

Health Technology Assessment

147

190

View full text Add to dashboard Cite

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“…APRI, AST/ALT, platelets, AST, albumin, total bilirubin and alkaline phosphatase which are well-known predictors of advanced liver diseases (9)(10)(11)(12)(13)(14)(15) (9). In this study, the cutoff values of APRI were set at 0.…”

Section: Discussionmentioning

confidence: 99%

“…(9). APRI has been used in the evaluation of patients with alcoholic liver fibrosis, CHB, and CHC (9)(10)(11)(12)(13) T a b l e 1 . Cl i n i c a l Ch a r a c t e r i s t i c s o f Ch r o n i c He p a t i t i s P a t i e n t s i n T h i s S t u d (Fig.…”

Section: Hepatitis B Virus (Hbv) and Hepatitis C Virus (Hcv) The Majmentioning

confidence: 99%

Retrospective Evaluation of Serum Markers APRI and AST/ALT for Assessing Liver Fibrosis and Cirrhosis in Chronic Hepatitis B and C Patients with Hepatocellular Carcinoma

et al. 2008

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“…It is an inexpensive widely available tool [11] that can predict accurately mild fibrosis in patients with a value < 0.42 and those with a value > 1.2 are diagnosed a significant grade of fibrosis. APRI establishes a 90% negative predictive value for the absence of fibrosis and a 91% of positive predictive value for its presence [12][13][14] . Previous studies have not explored the usefulness of noninvasive tests to assess liver fibrosis for the prediction of viral response in hepatitis C naive patients.…”

Section: Introductionmentioning

confidence: 99%

APRI as a predictor of early viral response in chronic hepatitis C patients

Mata‐Marín¹,

Fuentes-Allen²,

Gaytán-Martı́nez³

et al. 2009

WJG

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AIM:To evaluate the aspartate aminotransferase (AST) to platelet ratio index (APRI) as a predictive factor of early viral response in chronic hepatitis C naive patients. METHODS:We performed an ambispective casecontrol study. We enrolled chronic hepatitis C naive patients who were evaluated to start therapy with PEGylated interferon a-2b (1.5 mg/kg per week) and ribavirin (> 75 kg: 1200 mg and < 75 kg: 1000 mg). Patients were allocated into two groups, group 1: Hepatitis C patients with early viral response (EVR), group 2: Patients without EVR. Odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the relationship between each risk factor and the EVR in both groups. RESULTS:During the study, 80 patients were analyzed, 45 retrospectively and 35 prospectively. The mean ± SD age of our subjects was 42.9 ± 12 years; weight 70 kg (± 11.19), AST 64.6 IU/mL (± 48.74), alanine aminotransferase (ALT) 76.3 IU/mL (± 63.08) and platelets 209 000 mill/mm 3 (± 84 429). Fifty-five (68.8%) were genotype 1 and 25 (31.3%) were genotype 2 or 3; the mean hepatitis C virus RNA viral load was 2 269 061 IU/mL (± 7 220 266). In the univariate analysis, APRI was not associated with EVR CONCLUSION:APRI was not a predictor of EVR in chronic hepatitis C; Genotype 1 was the only predictive factor associated with the absence of EVR in our patients.

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APRI: An Easy and Validated Predictor of Hepatic Fibrosis in Chronic Hepatitis C

Abstract: The APRI is a good estimator of hepatic fibrosis and was more accurate in a prospective group than a retrospective one. It potentially could be used to decrease the number of liver biopsies.

Cited by 111 publications

References 24 publications

Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic review and economic evaluation

Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic review and economic evaluation

Retrospective Evaluation of Serum Markers APRI and AST/ALT for Assessing Liver Fibrosis and Cirrhosis in Chronic Hepatitis B and C Patients with Hepatocellular Carcinoma

APRI as a predictor of early viral response in chronic hepatitis C patients

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