Validation of three noninvasive laboratory variables to predict significant fibrosis and cirrhosis in patients with chronic hepatitis C in Saudi Arabia

Abstract

BACKGROUNDWe tested the clinical utility of the platelet count, the aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, and the AST to platelet ratio index (APRI) score in predicting the presence or absence of advanced fibrosis and cirrhosis in patients with chronic hepatitis C in Saudi Arabia.METHODSLiver biopsy procedures performed on chronic hepatitis C patients in our gastroenterology unit at King Khalid University Hospital were traced from records between the years 1998 to 2003. The hospital computer database was then accessed and detailed laboratory parameters obtained. By plotting receiver operating characteristic curves (ROC), three selected models (platelet count, AST/ALT ratio, and the APRI score) were compared in terms of the best variable to predict significant fibrosis.RESULTSTwo hundred and forty-six patients with hepatitis C were included in this analysis. Overall, 26% of patients had advanced fibrosis. When comparing the three above-mentioned prediction models, the APRI score was the one associated with the highest area under the curve (AUC) = 0.812 (95% CI, 0.756–0.868) on the ROC curves, compared to the platelet count and AST/ALT ratio, which yielded an AUC of 0.783 (0.711–0.855) and 0.716 (0.642–0.789), respectively.CONCLUSIONThe APRI score seemed to be the best predictive variable for the presence or absence of advanced fibrosis in Saudi hepatitis C patients.

The natural history and long‐term outcomes in patients with chronic hepatitis C genotype 4 after interferon‐based therapy

“…We have previously studied and validated the APRI in 246 Saudi hepatitis C patients with chronic hepatitis in comparison with liver biopsy and found it to be reliable as well. APRI scores were found to give the best predictive variable for the presence or absence of advanced fibrosis in .…”

“…Manufacturer's guidelines for estimation of fibrosis stages were used as follows: Fibrosis stage 0 (F0) = 0–5 kPa, stage 1 (F1) = 5–7.5 kPa, stage 2 (F2) = 7.6–10 kPa, stage 3 (F3) = 10.1–15 kPa and stage 4 (F4) = more than 15 kPa. The third non‐invasive marker was the APRI score . The APRI score was calculated by dividing the AST level by 45 (upper limit of normal), multiplying it by 100 and then dividing the total by the platelet count.…”

“…The APRI score was calculated by dividing the AST level by 45 (upper limit of normal), multiplying it by 100 and then dividing the total by the platelet count. We adopted the validated cut‐off point from our previous study where a score of more than 1.5 was found to predict correctly the presence of advanced fibrosis . A cut‐off value of less than 0.5 was able to predict the absence of advanced fibrosis.…”

Virological and clinical characteristics of delta hepatitis in Central Europe

“…More than half of patients (53%) showed an APRI‐score above two, which has been shown to be highly predictive for the presence of liver cirrhosis in hepatitis C infection [19–21]. About 1/3 of patients (34%) presented with an AST/ALT ratio above one.…”