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Diagnostic accuracy of transient elastography (FibroScan) versus the aspartate transaminase to platelet ratio index in assessing liver fibrosis in chronic hepatitis B: The role in primary care setting
  1. C Rinaldi A Lesmana1,2,
  2. Simon Salim1,
  3. Irsan Hasan1,
  4. Andri S Sulaiman1,
  5. Rino A Gani1,
  6. Levina S Pakasi2,
  7. Laurentius A Lesmana1,2,
  8. Ening Krisnuhoni1,3,
  9. Unggul Budihusodo1
  1. 1Department of Internal Medicine, University of Indonesia, Jakarta, Indonesia
  2. 2Digestive Disease Center, Medistra Hospital, Jakarta, Indonesia
  3. 3Department of Anatomical Pathology, University of Indonesia, Jakarta, Indonesia
  1. Correspondence to C Rinaldi A Lesmana, Department of Internal Medicine, University of Indonesia, Jakarta, Indonesia, Jl. Diponegoro No 71, Jakarta 10430, Indonesia; medicaldr2001id{at}yahoo.com

Abstract

Background A non-invasive method to assess liver fibrosis by measuring liver stiffness with transient elastography (TE) has been recently introduced. The role of TE among chronic hepatitis B (CHB) patients in starting antiviral therapy in the primary care setting is still controversial because of its high cost. The AST to platelet ratio index (APRI) could be a much cheaper alternative.

Objectives This study compares the diagnostic accuracy of TE and APRI in assessing liver fibrosis in CHB patients.

Patients and Methods A cross-sectional study in CHB patients intending to start antiviral treatment. Liver fibrosis was staged according to the METAVIR scoring system. Liver stiffness was measured by TE performed on the same day with liver biopsy, while APRI was calculated as follows: APRI=(AST/upper limit of normal)×100/platelet count (109/l). Cutoff levels of liver stiffness and APRI were calculated by using the receiver operating characteristic curve to detect significant liver fibrosis, defined as fibrosis stage F2 or more.

Results 117 patients were enrolled in the study; their mean age was 40.6±10.97 years. The median liver stiffness was 5.9 kPa (2.5–48 kPa) and the median APRI was 0.239 (0.09–2.73). The cutoff level of liver stiffness was 5.85 kPa for ≥F2 with an AUC of 0.614, 60.3% sensitivity, 63.6% specificity, 73.3% PPV, 49.1% NPV and a LR+ of 1.66. The APRI cutoff level was 0.235 for F≥2 with an AUC of 0.693, 64.4% sensitivity, 70.5% specificity, 78.3% PPV, 54.4% NPV and a LR+ of 2.18. Both methods gave comparable diagnostic accuracy.

Conclusion APRI is a useful marker to screen liver fibrosis in the primary care setting when TE is not available.

  • APRI
  • chemical pathology
  • chronic hepatitis B patients
  • colorectal cancer
  • diagnostic accuracy
  • diagnostic screening
  • gall bladder
  • hepatitis
  • laboratory tests
  • liver
  • liver fibrosis
  • molecular biology
  • nutrition
  • oncogenes
  • pancreas
  • p53
  • transient elastography

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was issued by the Ethical Committee of Medical Research, Faculty of Medicine, University of Indonesia.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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