Investigating the Efficiency of APRI, FIB-4, AAR and AARPRI as Noninvasive Markers for Predicting Hepatic Fibrosis in Chronic Hepatitis B Patients in Bangladesh

Sha, Fazley Rabbi; Pk, Md. Moyen Uddin; Abuelezz, Nermeen Z.; Pervin, Rumana; Talukder, Rabiul Islam; Begum, Momtaj; Rahman, M. Abdel

doi:10.2174/1874285801913010034

Cited by 11 publications

(9 citation statements)

References 23 publications

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“…In our study, we did not find significant elevations of Bl (µmol/L), cholesterol (mmol/L), β-lipoproteins (g/L), AST (U/L), ALT (U/L) in all groups of patients. The use of indexes is a more convenient, cheap and non-invasive method to identify possible fibrotic changes, as also reported by other authors (10,(14)(15)(16)(17)(18) . Liver damage can significantly complicate JIA treatment with MTX; therefore, studies on non-invasive methods for the diagnosis and assessment of liver steatosis and fibrosis as prognostic factors seem to be promising.…”

Section: Discussionsupporting

confidence: 58%

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Fibrosis indexes in adolescents with juvenile idiopathic arthritis treated with methotrexate

Parkhomenko¹,

Strashok²,

Pavlov³

et al. 2021

Pediatr Med Rodz

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Juvenile idiopathic arthritis is the most common form of arthritis in children and adolescents. Methotrexate is the mainstay of juvenile idiopathic arthritis treatment. Methotrexate is well known to cause serum aminotransferase elevations, and longterm therapy has been linked to the development of fatty liver disease, fibrosis and even cirrhosis. The aim of the study was to assess non-invasive liver fibrosis indexes in adolescents with juvenile idiopathic arthritis treated with methotrexate. Materials and methods: A total of 68 children with juvenile idiopathic arthritis were enrolled in the study. A total of 68 children – 25 boys (36.8%) and 43 girls (63.2%) – were examined. The children were divided into four groups based on the methotrexate cumulative dose. The following data were analysed: total bilirubin and its fractions, cholesterol, β-lipoproteins, aspartate transaminase, alanine aminotransferase. Fibrosis indexes, i.e. APRI, FIB-4 score, AAR, AARPRI, were studied. Results: When studying the dynamics of non-invasive indices, their heterogeneous nature and cumulative dose dependence are determined. Statistically significant changes in fibrosis indexes and biochemical parameters were observed when the children reached cumulative methotrexate doses of 1 g and 3 g. Conclusions: It is possible to monitor carefully liver condition during the whole treatment and conduct a more in-depth examination only if it is necessary. Our data shows that the APRI index (AST to platelet ratio index) is most indicative.

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Section: Discussionsupporting

confidence: 58%

“…Liver fibrosis and steatosis indexes can be used to identify a group of children who need careful monitoring of the liver. However, the criteria for the appropriateness of using these indexes with JIA are still to be studied (14)(15)(16)(17)(18) . The use of fibrosis and steatosis indexes has been repeatedly studied.…”

Section: Introductionmentioning

confidence: 99%

Fibrosis indexes in adolescents with juvenile idiopathic arthritis treated with methotrexate

Parkhomenko¹,

Strashok²,

Pavlov³

et al. 2021

Pediatr Med Rodz

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“…13,14 The most accurate non-invasive methods to assess fibrosis are liver stiffness measurements (elastography), followed by several scoring methods such as the AST-to-platelet ratio index (APRI), the fibrosis index based on four factors (FIB-4), and the AST-to-ALT ratio (AAR). 2,[18][19][20] Adapting non-invasive liver fibrosis modalities to each type of chronic liver disease and each region is necessary due to the heterogeneity of outcomes. A stepwise diagnostic analysis has yet to be conducted to determine whether M2BPGi should be utilized alone or in conjunction with modalities to assess liver fibrosis.…”

Section: Introductionmentioning

confidence: 99%

Revisiting Mac-2-Binding Protein Glycosylation Isomer (M2BPGi) for Diagnosing High-Risk Liver Fibrosis: A Stepwise Diagnostic Analysis

Bestari,

Haryono,

Wijaya

et al. 2024

F1000Res

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Abstract* Background The level of liver fibrosis is the basis for the treatment of chronic hepatitis B (CHB), and it is necessary to adapt non-invasive liver fibrosis modalities. We aimed to investigate the use of M2BPGi as a single or combined diagnostic modality for liver fibrosis in CHB patients through a stepwise diagnostic analysis. Methods Cross-sectional data were taken from patients between October 2021 and August 2022. Demographic data, blood profile, liver function, and liver stiffness were measured in CHB patients over 18 years old, willing to take part in the research, and had complete data. APRI, FIB-4, and AAR were calculated using the well-known formulas. Serum M2BPGi-levels were converted into a cut-off index (COI). The patients were divided into low-risk (LR) and high-risk fibrosis (HR) groups. A cut-off for each predictor variable to differentiate between the LR and HR groups was determined. The obtained cut-off was assessed for its association with the grouping of liver elastography results. Models to diagnose the liver stiffness measurement (LSM) ≥8 kPa were created and compared through multivariate and ROC analyses. Results The number of patients that met the inclusion and exclusion criteria was 143 (HR = 65, LR = 78). The cut-off for diagnosing LSM ≥8kPa was 0.311, 0.742, 0.635, and 1.434 for APRI, FIB-4, AAR, and M2BPGi, respectively. This cut-off was significantly associated with the results of the HR and LR groupings. A multivariate analysis found that FIB4, AAR, and M2BPGi added significantly to the model. Statistically, the most optimal use of M2BPGi was combined with FIB-4, with an AUC of 0.835. Conclusions The optimal cut-off of M2BPGi for diagnosing high-risk liver fibrosis in this study was 1.434. M2BPGi should be used with FIB-4 as a diagnostic tool for diagnosing liver fibrosis, especially in the absence of a liver biopsy or elastography.

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“…They include the parameters of the patient’s age, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), albumin, and platelet count (PLT). Laboratory tests that include these parameters are routinely completed to check liver function and obtain complete blood analyses, making these parameters easily available for use and consequent documentation [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Non-invasive Fibrosis Markers for Predicting Esophageal Varices: A Potential Alternative to Endoscopic Screening

Ali,

Slah-Ud-Din,

Afzal

et al. 2024

Cureus

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Background: Chronic liver infections and diseases lead to chronic liver injury, which results in fibrosis. Due to this continuous scarring and regeneration, cirrhosis occurs, which is also responsible for several adverse sequelae, including but not limited to esophageal varices. Cirrhosis has resulted in patients' increased morbidity and mortality, especially in low socioeconomic settings such as Pakistan. Endoscopy is the gold standard for measuring the presence or absence of esophageal varices, along with their grade. Currently, some non-invasive markers (aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), fibrosis 4 (FIB-4), AAR to platelet ratio index (AARPRI), aspartate aminotransferase-to-platelet ratio index (APRI), S-index, King’s score) are being established that make use of laboratory tests, such as a complete blood profile, liver function profile, and coagulation profile, to estimate the extent of hepatic fibrosis. Objectives: The objective of this study is to establish a correlation between non-invasive markers of fibrosis and the presence of esophageal varices and to assess their potential as a substitute for gastrointestinal endoscopy screening. Additionally, the study aims to compare these six scores, thereby generating data on their individual and relative accuracy. Methodology: This was a cross-sectional study conducted at the Shalamar Institute of Health Sciences, Lahore, Pakistan. Outpatient (OPD) data were obtained from the Shalamar online portal system from June 2022 to December 2022. Laboratory tests, abdominal ultrasounds, and endoscopy results were accessed and recorded in the questionnaire. The patient’s medical records and contact numbers were also noted in case further questions arose. Data were then compiled into a Microsoft Excel spreadsheet (Microsoft Corp., Redmond, WA) and analyzed after computing the non-invasive procedure formulas. It was analyzed using IBM SPSS Statistics for Windows, version 20.0 (IBM Corp., Armonk, NY). P-values were calculated, and conclusions were drawn. Results: Of the sample size of 100 patients with liver damage and injury, 60% were male and 40% were female. Among males, 15% had a milder (grade 1) degree of esophageal varices, and 45% had a moderate to advanced degree (grades 2-3) of esophageal varices. Among females, 19% had mild (grade 1) varices, while 21% had severe (grade 3) varices. The most common cause of varices in patients who had developed fibrosis and/or cirrhosis was hepatitis C, with a wide margin of other causes. The p-values obtained showed that from the selected list of non-invasive markers of fibrosis, only FIB-4 and AARPRI were statistically significant with p-values of 0.036 and 0.022, respectively. Practical implications: Though endoscopy is currently the gold-standard procedure for detecting the presence or absence and grade of esophageal varices, it is invasive, which makes the patients extremely uncomfortable and apprehensive. It can also lead to post-procedure infec...

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Investigating the Efficiency of APRI, FIB-4, AAR and AARPRI as Noninvasive Markers for Predicting Hepatic Fibrosis in Chronic Hepatitis B Patients in Bangladesh

Cited by 11 publications

References 23 publications

Fibrosis indexes in adolescents with juvenile idiopathic arthritis treated with methotrexate

Fibrosis indexes in adolescents with juvenile idiopathic arthritis treated with methotrexate

Revisiting Mac-2-Binding Protein Glycosylation Isomer (M2BPGi) for Diagnosing High-Risk Liver Fibrosis: A Stepwise Diagnostic Analysis

Non-invasive Fibrosis Markers for Predicting Esophageal Varices: A Potential Alternative to Endoscopic Screening

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