Aim: The aim of this study was to evaluate the performance of non-invasive APRI score in predicting significant fibrosis and cirrhosis in patients with chronic HCV infection who underwent liver biopsy.
Introduction: Determining the stage of liver fibrosis is essential in managing patients with chronic hepatitis C virus. In chronic HCV infection, liver biopsy is the gold standard method for assessing stage of liver fibrosis, but it is invasive with potential complications. Non-invasive markers have been proposed and APRI score (aspartate aminotransferase (AST)-to-platelet ratio index) has been shown as a simple and inexpensive marker of liver fibrosis.
Methods: This retrospective study included 142 patients with chronic hepatitis C who had undergone liver biopsy from January 2013 to December 2015. Liver fibrosis was staged according to METAVIR (F0-F4) scoring system. The diagnostic performances of APRI score in predicting significant fibrosis (F2-F4) and cirrhosis (F4) were evaluated and compared by ROC curves.
Results: Fifty-three (37.3%) patients had significant fibrosis and 18 (12.7%) had cirrhosis. The areas under the ROC curve of APRI for predicting significant fibrosis and cirrhosis were 0.76 and 0.81. Using recommended cut-off values for APRI test, significant fibrosis could be identified in 26% and cirrhosis in 22% patients, but specificity for significant fibrosis was 88% and for cirrhosis 91%. Results have also shown that lower platelets count in our patients is associated with higher stage of fibrosis (p<0.0001).
Conclusion: APRI test shows low sensitivity and high specificity in the distinction between mild and significant fibrosis, and it shows good sensitivity in the evaluation of patients without cirrhosis and excellent specificity in patients with cirrhosis. Non-invasive biochemical tests and scores should be used only as additional criteria in differentiating the stage of liver fibrosis in chronic HCV infection, along with other non-invasive methods.