Akpoigbe Kesiena, Bath Khushbir, Genao Alvaro, Culpepper-Morgan Joan
Internal Medicine, Harlem Hospital Center, Columbia University College of Physicians and Surgeons, New York City, USA.
Gastroenterology, Harlem Hospital Center, Columbia University College of Physicians and Surgeons, New York City, USA.
Cureus. 2023 Feb 15;15(2):e35032. doi: 10.7759/cureus.35032. eCollection 2023 Feb.
Liver biopsy is the gold standard for fibrosis staging. However, it is limited by significant complications. Non-invasive markers of fibrosis have been developed as an alternative to liver biopsy. The performance of these different markers varies with the etiology of liver fibrosis and possibly amongst different ethnicities. We aim to assess the performance of non-invasive markers of liver fibrosis amongst Hispanics and African Americans.
This is a retrospective cohort analysis of patients who had liver biopsy as part of their evaluation of chronic liver disease. One hundred and twenty-six records were analyzed. Univariate and multivariate analyses were performed. Probit regression receiver operating characteristic curve analysis was used to assess the sensitivity of the different non-invasive biomarkers and underlying variables with respect to liver biopsy. The following non-invasive markers for fibrosis were used: Fibrosis-4 (FIB-4), aspartate aminotransferase (AST) to platelet ratio index (APRI), age-platelet, AST/alanine aminotransferase (AST/ALT) ratio, fibrosis cirrhosis index (FCI), and fibrosis index (FI).
About two-thirds of the study population were African Americans with majority of the study population having chronic liver disease from viral infection. Minimal to no fibrosis by the METAVIR (an acronym for Meta-analysis of Histological Data in Viral Hepatitis) score was found in 58% of patients compared to 42% with moderate to severe fibrosis. Hispanics were more likely than Blacks to have hepatic steatosis. Age significantly increased the sensitivity and specificity of APRI and age-platelet scores. The AST/ALT score had a lower sensitivity for liver fibrosis in women compared to men in our study population. The sensitivity of FIB-4 and age-platelet was higher in Hispanics compared to African Americans while the opposite was the case for APRI, AST/ALT, FCI, and FI.
Non-invasive biomarkers are useful in detecting liver fibrosis. FIB-4 and age-platelet have a high sensitivity in Hispanics while African Americans have a high sensitivity for APRI, AST/ALT, FCI, and FI. It is worth noting that these non-invasive biomarkers had variable performances when ethnicity, age, and sex were considered in our population.
肝活检是纤维化分期的金标准。然而，它受到严重并发症的限制。已开发出非侵入性纤维化标志物作为肝活检的替代方法。这些不同标志物的性能因肝纤维化病因不同而有所差异，在不同种族中可能也存在差异。我们旨在评估西班牙裔和非裔美国人中肝纤维化非侵入性标志物的性能。
这是一项对因慢性肝病评估而进行肝活检的患者的回顾性队列分析。分析了126份记录。进行了单因素和多因素分析。使用概率回归接收器操作特征曲线分析来评估不同非侵入性生物标志物和潜在变量相对于肝活检的敏感性。使用了以下纤维化非侵入性标志物：纤维化-4（FIB-4）、天冬氨酸转氨酶（AST）与血小板比值指数（APRI）、年龄-血小板、AST/丙氨酸转氨酶（AST/ALT）比值、纤维化肝硬化指数（FCI）和纤维化指数（FI）。
约三分之二的研究人群是非裔美国人，大多数研究人群患有病毒感染引起的慢性肝病。根据METAVIR（病毒性肝炎组织学数据荟萃分析的首字母缩写）评分，58%的患者纤维化程度为轻度至无纤维化，42%的患者为中度至重度纤维化。西班牙裔比黑人更易发生肝脂肪变性。年龄显著提高了APRI和年龄-血小板评分的敏感性和特异性。在我们的研究人群中，AST/ALT评分对女性肝纤维化的敏感性低于男性。与非裔美国人相比，西班牙裔中FIB-4和年龄-血小板的敏感性更高，而APRI、AST/ALT、FCI和FI则相反。
非侵入性生物标志物有助于检测肝纤维化。FIB-4和年龄-血小板在西班牙裔中具有高敏感性，而非裔美国人对APRI、AST/ALT、FCI和FI具有高敏感性。值得注意的是，在我们的人群中考虑种族、年龄和性别时，这些非侵入性生物标志物的表现各不相同。
