Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis B-related fibrosis: a leading meta-analysis

Abstract

BackgroundThe aspartate aminotransferase-to-platelet ratio index (APRI), a tool with limited expense and widespread availability, is a promising noninvasive alternative to liver biopsy for detecting hepatic fibrosis. The objective of this study was to systematically review the performance of the APRI in predicting significant fibrosis and cirrhosis in hepatitis B-related fibrosis.MethodsAreas under summary receiver operating characteristic curves (AUROC), sensitivity and specificity were used to examine the accuracy of the APRI for the diagnosis of hepatitis B-related significant fibrosis and cirrhosis. Heterogeneity was explored using meta-regression.ResultsNine studies were included in this meta-analysis (n = 1,798). Prevalence of significant fibrosis and cirrhosis were 53.1% and 13.5%, respectively. The summary AUCs of the APRI for significant fibrosis and cirrhosis were 0.79 and 0.75, respectively. For significant fibrosis, an APRI threshold of 0.5 was 84% sensitive and 41% specific. At the cutoff of 1.5, the summary sensitivity and specificity were 49% and 84%, respectively. For cirrhosis, an APRI threshold of 1.0-1.5 was 54% sensitive and 78% specific. At the cutoff of 2.0, the summary sensitivity and specificity were 28% and 87%, respectively. Meta-regression analysis indicated that the APRI accuracy for both significant fibrosis and cirrhosis was affected by histological classification systems, but not influenced by the interval between Biopsy & APRI or blind biopsy.ConclusionOur meta-analysis suggests that APRI show limited value in identifying hepatitis B-related significant fibrosis and cirrhosis.

Fibrosis assessment in patients with chronic hepatitis B virus (HBV) infection

“…The second scale detects clinically significant fibrosis (Ishak stage 3-6); an APRI score >1.5 is the cut-off for significant fibrosis, whereas a score <0.5 can rule it out (45). In a meta-analysis published in 2012 (46), which included nine studies (n=1,798), the APRI gave AUROCs for significant fibrosis and cirrhosis of 0.79 and 0.75, respectively. For significant fibrosis, an APRI cut-off of 0.5 had a sensitivity of 84% and a specificity of 41%, while a cut-off of 1.5 had a sensitivity of 49% and a specificity of 84%; for cirrhosis a cut-off range of 1.0-1.5 had sensitivity and specificity of 54% and 78% respectively and a cut-off of 2 28% and 87% respectively, leading the authors to conclude that the APRI had limited application in the identification of significant fibrosis or cirrhosis in HBV.…”

Accumulation of mutations in reverse transcriptase of hepatitis B virus is associated with liver disease severity in treatment-naïve Chinese patients with chronic hepatitis B

“…32,33 In this study, 164 chronic hepatitis B patients underwent liver biopsies before treatment. Liver fibrosis in patients with RT mutations was more severe than in patients without RT mutations, and liver fibrosis in patients with multiple mutant sites (≥2) was more severe than in patients with a single mutant site.…”

Rethinking the Role of Liver Biopsy in the Era of Personalized Medicine

“…It was used in several studies conducted in cohorts of patients with hepatitis C and showed a rather good diagnostic performance and reproducibility, [110] particularly for cirrhosis. Forns and colleagues reported a fibrosis index (Forns' index) based on platelet count, γ-glutamyl transferase (GGT), and cholesterol levels [111].…”