EVALUATION OF DIAGNOSTIC ACCURACY OF APRI FOR PREDICTION OF FIBROSIS IN HEPATITIS C PATIENTS
AbstractBackground: Several non-invasive markers are being used to assess the structural liver damage inpatients with chronic hepatitis C (CHC). We evaluated Aspartate aminotransferase (AST) toplatelet ratio index (APRI) in comparison with Metavir scoring for assessing the severity ofhepatic fibrosis in the CHC patients in district Rawalpindi. Methods: One hundred twenty CHCpatients, naive for HCV treatment, underwent liver biopsy in tertiary care hospitals of districtRawalpindi, 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) andthose with mild/moderate fibrosis (F0, F1, F2) from advanced fibrosis (F3, F4) based on APRIscore as compared to liver biopsy. Results: Liver biopsies examination revealed that out of 120patients 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 1.5with negative predictive value (NPV), Positive predictive value (PPV), sensitivity and specificityof 78%, 72%, 66%, 83% and 58%, 90%, 41% and 90% respectively. Eighty-seven (66%) CHCpatients 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 couldcorrectly identify significant fibrosis in 48% and advanced fibrosis in 66% cases with acceptabledegree 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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