EVALUATION OF DIAGNOSTIC ACCURACY OF APRI FOR PREDICTION OF FIBROSIS IN HEPATITIS C PATIENTS
Abstract
Background: Several non-invasive markers are being used to assess the structural liver damage inpatients with chronic hepatitis C (CHC). We evaluated Aspartate aminotransferase (AST) to
platelet ratio index (APRI) in comparison with Metavir scoring for assessing the severity of
hepatic fibrosis in the CHC patients in district Rawalpindi. Methods: One hundred twenty CHC
patients, naive for HCV treatment, underwent liver biopsy in tertiary care hospitals of district
Rawalpindi, participated in the study. Liver biopsies were reviewed by Metavir scoring system.
Serum AST was analyzed by IFCC method. Platelets were measured on a haematology Analyzer.
Patients with mild fibrosis (F0, F1) were differentiated from significant fibrosis (F2, F3, F4) and
those with mild/moderate fibrosis (F0, F1, F2) from advanced fibrosis (F3, F4) based on APRI
score as compared to liver biopsy. Results: Liver biopsies examination revealed that out of 120
patients 10 (8.3%) had no fibrosis (F0), 46 (38%) portal fibrosis (F1), 34 (28%) septal fibrosis
(F2), 21 (18%) bridging fibrosis (F3) and 9 (8%) cirrhosis (F4). APRI correctly classified 58
(48%) patients of significant fibrosis with AUC=0.82 (95% CI, 0.73-0.88) at cut-off 0.5 and 1.5
with negative predictive value (NPV), Positive predictive value (PPV), sensitivity and specificity
of 78%, 72%, 66%, 83% and 58%, 90%, 41% and 90% respectively. Eighty-seven (66%) CHC
patients were correctly classified for advanced fibrosis with AUC=0.87(95%CI 0.79-0.94) at cutoffs 0.90 and 1.75 with a 95%NPV at 0.90 and 78% PPV at 1.75. Conclusion: APRI could
correctly identify significant fibrosis in 48% and advanced fibrosis in 66% cases with acceptable
degree of diagnostic accuracy in CHC patients in our clinical practice.
Keywords: Chronic hepatitis C, APRI, liver biopsy, Metavir score, AST, diagnostic accuracy
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