Association between Aspartate Aminotransferase-to-Platelet Ratio Index and Hepatocellular Carcinoma Risk in Patients with Chronic Hepatitis: A Meta-Analysis of Cohort Study

Abstract

Background and Aim Aspartate aminotransferase-to-platelet ratio index (APRI) is widely used in the assessment of fibrosis and cirrhosis, especially in patients with chronic hepatitis. However, the prognostic value of APRI in patients with chronic hepatitis with regard to the prediction of hepatocellular carcinoma (HCC) occurrence remains controversial. The objective of this meta-analysis is to investigate the association between APRI and HCC risk on the basis of cohort studies. Methods We systematically reviewed PubMed, EMBASE, Web of Science, and Chinese National Knowledge Infrastructure databases for relevant cohort studies up to May 1, 2019. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) for total and subgroup analyses were calculated with Stata 12.0 software for the assessment of the relationship between APRI and HCC risk. Results A total of 13 studies, involving 8897 patients, were included in the meta-analysis, of which 11 explored the association between pretreatment APRI and HCC risk and four reported the relationship between posttreatment APRI and HCC risk. Pooled results showed that an elevated level of pretreatment APRI was associated with increased HCC risk (HR = 2.56, 95% CI: 1.78–3.68). When stratified by hepatitis type, high pretreatment APRI predicted HCC development in patients with chronic hepatitis B (CHB) and C (CHC) but not in alcoholic liver cirrhosis (ALC). In the subgroup analyses of study region, cut-off value, sample size, and analysis method, the relationship between high pretreatment APRI and increased HCC risk was significant. Meanwhile, patients with a high level of posttreatment APRI suffered from high HCC risk (HR = 3.69, 95% CI: 2.52–5.42). Conclusion: Results revealed a significant association between elevated APRI and HCC development in patients with chronic hepatitis, suggesting that APRI might serve as a valuable predictor for HCC risk in patients with chronic hepatitis.

East Asia expert opinion on treatment initiation for chronic hepatitis B

“…Liver stiffness measurement (LSM) has been shown to predict future HCC development in a dose‐dependent manner, with the risk beginning to increase at a threshold of 8 kPa 33,35 . In a recent meta‐analysis, an APRI at cut‐offs ranging from 0.5 to 2.57 also correlate with future HCC development 37 . The expert panel therefore agrees that liver stiffness of ≥8 kPa and/or APRI of ≥1.5 are reasonable indications for anti‐viral therapy.…”

Thrombocytopenia in Virus Infections

“…The incidence of thromboembolic complications is elevated in individuals during and after influenza virus infection, for example, a relation which may not be apparent to physicians diagnosing and treating influenza-like illness [ 1 ]. Platelet counts during peak symptomatic disease have also been found to be a marker of disease severity in certain viral infections, [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ] or can serve as a first clue towards diagnosing chronic viral infections [ 20 , 21 , 22 , 23 ]. These phenomena are typically not explained by changes in platelet quantity, but rather by the effects of viral infections on platelet function.…”

Assessment of Prognostic Value of Aspartate Aminotransferase-to-Platelet Ratio Index in Patients With Hepatocellular Carcinoma: Meta-Analysis of 28 Cohort Studies

“…In 2003, aspartate aminotransferase (AST)-to-platelet (PLT) index (APRI) was first proposed by Wai et al as a substitute index for the diagnosis of advanced fibrosis and cirrhosis in the patients with chronic hepatitis C; compared with liver biopsy, APRI is a simple, feasible, and non-invasive predictor and is derived from routine laboratory data calculated as the ratio of [(aspartate aminotransferase/upper limit of normal value)/platelet counts (× 10 9 /L)] × 100 (8)(9)(10). Meta-analysis has revealed that increased APRI levels can predict the risk of HCC development in the patients with chronic hepatitis (11). Furthermore, the preoperative APRI scores are associated with the postoperative complications of HCC and can predict the occurrence of hepatic failure after liver resection (12)(13)(14)(15).…”