Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis C–related fibrosis: A systematic review

Authors

  • Abdel Aziz M. Shaheen,

    1. Liver Unit, Division of Gastroenterology, Department of Medicine; University of Calgary, Calgary, Alberta, Canada
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    • Both authors contributed equally to this work.

  • Robert P. Myers

    Corresponding author
    1. Liver Unit, Division of Gastroenterology, Department of Medicine; University of Calgary, Calgary, Alberta, Canada
    • Liver Unit, University of Calgary, G126, 3330 Hospital Drive NW, Calgary, AB, Canada T2N 4N1
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    • Potential conflict of interest: The authors have no competing interests to disclose. Although Dr. Myers has published manuscripts on the FibroTest, he has never had a relationship with Biopredictive, the company marketing this test.

    • Both authors contributed equally to this work.

    • fax: 403-210-9368


Abstract

The development of noninvasive markers of liver fibrosis is a clinical and research priority. The aspartate aminotransferase-to-platelet ratio index (APRI) is a promising tool with limited expense and widespread availability. Our objective was to systematically review the performance of the APRI in hepatitis C virus (HCV)–infected patients. Random effects meta-analyses and areas under summary receiver operating characteristic curves (AUC) were examined to characterize APRI accuracy for significant fibrosis (stages 2–4) and cirrhosis. In 22 studies (n = 4,266), the summary AUCs of the APRI for significant fibrosis and cirrhosis were 0.76 [95% confidence interval (CI), 0.74–0.79] and 0.82 (95%CI, 0.79–0.86), respectively. For significant fibrosis, an APRI threshold of 0.5 was 81% sensitive and 50% specific. At a 40% prevalence of significant fibrosis, this threshold had a negative predictive value (NPV) of 80%, but could reduce the necessity of liver biopsy by only 35%. For cirrhosis, a threshold of 1.0 was 76% sensitive and 71% specific. At a 15% cirrhosis prevalence, the NPV of this threshold was 91%. Higher APRI thresholds had suboptimal positive predictive values except in settings with a high prevalence of cirrhosis. APRI accuracy was not affected by the prevalence of advanced fibrosis, or study and biopsy quality. However, the accuracy for cirrhosis was greater in studies including human immunodeficiency virus (HIV)/HCV–co-infected patients. Conclusion: The major strength of the APRI is the exclusion of significant HCV-related fibrosis. Future studies of novel markers should demonstrate improved accuracy and cost-effectiveness compared with this economical and widely available index. (HEPATOLOGY 2007.)

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