Wadhva Rajesh Kumar, Haque Muhammad Manzoorul, Luck Nasir Hassan, Tasneem Abbas Ali, Abbas Zaigham, Mubarak Muhammad
Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Ziauddin Medical University Hospital, Sindh, Karachi, Pakistan.
J Transl Int Med. 2018 Mar 28;6(1):38-42. doi: 10.2478/jtim-2018-0008. eCollection 2018 Mar.
The aim was to assess the diagnostic accuracy of APRI and FIB-4 in assessing the stage of liver fibrosis in end stage renal disease (ESRD) patients with chronic viral hepatitis and to compare the two tests with standard tru-cut liver biopsy.
The study was conducted at Sindh Institute of Urology and Transplantation Karachi (SIUT) from May 2010 to May 2014. All ESRD patients, being considered as candidates for renal transplantation and in whom liver biopsy was performed were included. Fibrosis stage was assessed on liver biopsy using Ishak scoring system. The serum transaminases and platelet counts were used to calculate APRI and FIB-4 scores.
Out of 109 patients, hepatitis C and B virus infections were present in 104 (95.4%) and 3(2.8%), respectively, while 2 (1.8%) patients had both infections. The mean Ishak fibrosis score was 1.95 ± 2. Advanced fibrosis was noted in 37 (34%) patients. Univariate analysis showed that advanced liver fibrosis was associated with lower platelets counts (=0.001) and higher aspartate aminotransferase (AST) (=0.001), alanine aminotransferase (ALT) (=0.022), APRI score (=0.001) and FIB-4 score (=0.001). On logistic regression analysis, only APRI score ( < 0.001) was found to be the independent variable associated with advanced liver fibrosis. APRI score cutoff ≥1 indicating advanced fibrosis showed sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 91.9%, 90.3%, 82.9%, 95.6%, respectively with area under the curve (AUC) of 0.97. Similarly, a FIB-4 score cutoff ≥1.1 had sensitivity, specificity, PPV and NPV of 70.27%, 66.67%, 52% and 81.36%, respectively with AUC of 0.74.
APRI is more accurate noninvasive test for assessing advanced liver fibrosis in ESRD patients as compared to FIB-4. It can be used to obviate the need for liver biopsy in this high risk population.
评估天冬氨酸氨基转移酶与血小板比值指数（APRI）和FIB-4在评估终末期肾病（ESRD）合并慢性病毒性肝炎患者肝纤维化分期中的诊断准确性，并将这两种检测方法与标准的经皮肝穿刺活检进行比较。
该研究于2010年5月至2014年5月在卡拉奇的信德泌尿与移植研究所（SIUT）进行。纳入所有被视为肾移植候选者且接受了肝活检的ESRD患者。使用Ishak评分系统对肝活检的纤维化分期进行评估。利用血清转氨酶和血小板计数计算APRI和FIB-4评分。
109例患者中，丙型肝炎病毒感染104例（95.4%），乙型肝炎病毒感染3例（2.8%），2例（1.8%）患者两种病毒均感染。Ishak纤维化评分的平均值为1.95±2。37例（34%）患者存在高级别纤维化。单因素分析显示，高级别肝纤维化与较低的血小板计数（P = 0.001）、较高的天冬氨酸氨基转移酶（AST，P = 0.001）、丙氨酸氨基转移酶（ALT，P = 0.022）、APRI评分（P = 0.001）和FIB-4评分（P = 0.001）相关。逻辑回归分析显示，只有APRI评分（P < 0.001）是与高级别肝纤维化相关的独立变量。APRI评分截断值≥1表明存在高级别纤维化，其敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为91.9%、90.3%、82.9%、95.6%，曲线下面积（AUC）为0.97。同样，FIB-4评分截断值≥1.1时，其敏感性、特异性、PPV和NPV分别为70.27%、66.67%、52%和81.36%，AUC为0.74。
与FIB-4相比，APRI是评估ESRD患者高级别肝纤维化更准确的无创检测方法。它可用于避免在这一高风险人群中进行肝活检。
