Unit of Infectious Diseases and Microbiology, Valme University Hospital, Sevilla, Spain.
Infectious Diseases Unit, Internal Medicine Service, University Hospital of A Coruña, A Coruña, Spain.
Medicine (Baltimore). 2021 Nov 19;100(46):e27838. doi: 10.1097/MD.0000000000027838.
Identification of advanced fibrosis/cirrhosis in hepatitis C virus (HCV)-infected patients should be a mainstay before starting treatment; however, the limited access of many centres to transient elastography (TE) is often a barrier for early assessments. We aimed to investigate the diagnostic accuracy of serum indexes for predicting liver stiffness.Retrospective analysis of HCV patients (with or without HIV coinfection) routinely assessed in 7 centres in Spain. The diagnostic accuracy of aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 (FIB-4), and their combinations was evaluated using a recent TE examination as a reference test (liver stiffness ≥ 9.5 kPa and ≥12.5 kPa for advanced fibrosis and cirrhosis, respectively). In addition to area under the receiving operating characteristic curves, sensitivity, specificity, and negative predictive value (NPV) and positive predictive value were estimated.The analysis included 1391 patients: 346 (25%) HIV-positive, 732 (53%) people who inject drugs, and 178 (13%) incarcerated. Advanced fibrosis and cirrhosis were found in 557 (40%) and 351 (25%) patients, respectively. APRI < 0.5 (n = 595; 43%) had an NPV of 95% for excluding cirrhosis. Combined FIB-4 < 1.45 with APRI < 0.5 (n = 467; 34%) had an NPV of 87% for excluding advanced fibrosis. Combined APRI > 2 and FIB-4 > 3.25 (n = 134; 10%) had a positive predictive value of 89% for advanced fibrosis. Globally, this approach would avoid the need for TE in 53% of patients. HIV coinfection did not influence diagnostic accuracy.Inexpensive and simple serum indexes confidently allowed identifying the absence of cirrhosis and the presence of advanced fibrosis in 53% of a heterogeneous series of real-world HCV patients with or without HIV infection.
在开始治疗前，应确定丙型肝炎病毒（HCV）感染患者是否存在晚期纤维化/肝硬化；然而，许多中心获得瞬态弹性成像（TE）的机会有限，这常常成为早期评估的障碍。我们旨在研究血清指标预测肝硬度的诊断准确性。
对西班牙 7 个中心常规评估的 HCV 患者（合并或不合并 HIV 感染）进行回顾性分析。使用最近的 TE 检查作为参考试验（肝硬度分别≥9.5kPa 和≥12.5kPa 用于诊断晚期纤维化和肝硬化），评估天冬氨酸转氨酶与血小板比值指数（APRI）、纤维化-4 指数（FIB-4）及其组合的诊断准确性。除了接受者操作特征曲线下面积外，还估计了敏感性、特异性、阴性预测值（NPV）和阳性预测值。
该分析包括 1391 例患者：346 例（25%）HIV 阳性，732 例（53%）为吸毒者，178 例（13%）为被监禁者。557 例（40%）和 351 例（25%）患者分别发现晚期纤维化和肝硬化。APRI＜0.5（n=595；43%）排除肝硬化的 NPV 为 95%。APRI＜0.5 且 FIB-4＜1.45（n=467；34%）联合排除晚期纤维化的 NPV 为 87%。APRI＞2 和 FIB-4＞3.25（n=134；10%）联合阳性预测值为 89%，用于诊断晚期纤维化。总体而言，该方法可避免 53%的患者需要进行 TE。HIV 合并感染并未影响诊断准确性。
这种简单且经济的血清指标可在存在或不存在 HIV 感染的丙型肝炎病毒患者的异质系列中，准确地确定 53%的患者是否存在肝硬化和晚期纤维化。
