Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: An updated meta-analysis

Abstract

The 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 update the 2007 meta-analysis to systematically assess the accuracy of APRI in predicting significant fibrosis, severe fibrosis, and cirrhosis stage in hepatitis C virus (HCV) monoinfected and HCV / human immunodeficiency virus (HIV) coinfected individuals. Studies comparing APRI versus biopsy in HCV patients were identified via a thorough literature search. Areas under summary receiver operating characteristic curves (AUROC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to examine the APRI accuracy for the diagnosis of significant fibrosis, severe fibrosis, and cirrhosis. Heterogeneity was explored using meta-regression. Twenty-one additional studies were eligible for the update and, in total, 40 studies were included in this review (n 5 8,739). The summary AUROC of the APRI for the diagnosis of significant fibrosis, severe fibrosis, and cirrhosis were 0.77, 0.80, and 0.83, respectively. For significant fibrosis, an APRI threshold of 0.7 was 77% sensitive and 72% specific. For severe fibrosis, a threshold of 1.0 was 61% sensitive and 64% specific. For cirrhosis, a threshold of 1.0 was 76% sensitive and 72% specific. Moreover, we found that the APRI was less accurate for the identification of significant fibrosis, severe fibrosis, and cirrhosis in HIV/HCV coinfected patients. Conclusion: Our large meta-analysis suggests that APRI can identify hepatitis C-related fibrosis with a moderate degree of accuracy. Application of this index may decrease the need for staging liver biopsy specimens among chronic hepatitis C patients. (HEPATOLOGY 2011;53:726-736)

Developing a ‘traffic light’ test with potential for rational early diagnosis of liver fibrosis and cirrhosis in the community

“…5 Alongside this project, a number of competing and perhaps equally effective non-invasive diagnostic methodologies have been published. [6][7][8][9][10] This traffic light system is probably no more accurate than the better ones, but it was developed specifically for use in primary care, with the aim of being intuitively easy for patients to understand.…”

Pancreatic Diabetes Mellitus and Heavy Drinking are Risk Factors for the Development of Liver Fibrosis in Alcoholic Chronic Pancreatitis

“…Noninvasive fibrosis scores including the aspartate aminotransferase to platelet ratio index (APRI) [25] and fibrosis-4 score (FIB-4) [26] were determined.…”

APASL consensus statements and recommendations for hepatitis C prevention, epidemiology, and laboratory testing

“…Although liver biopsy remains the gold standard to assess liver fibrosis, alternative noninvasive approaches for liver fibrosis have assumed great importance. Approaches include the following [192][193][194]:…”