Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: An updated meta-analysis§

Authors

  • Zhong-Hua Lin,

    1. Medical College of Qingdao University, Qingdao, Shandong Province, China
    2. Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, Shandong Province, China
    Search for more papers by this author
    • *These authors contributed equally to this work.

  • Yong-Ning Xin,

    1. Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, Shandong Province, China
    2. College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, Shandong Province, China
    Search for more papers by this author
    • *These authors contributed equally to this work.

  • Quan-Jiang Dong,

    1. Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, Shandong Province, China
    Search for more papers by this author
  • Qing Wang,

    1. Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, Shandong Province, China
    Search for more papers by this author
  • Xiang-Jun Jiang,

    1. Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, Shandong Province, China
    Search for more papers by this author
  • Shu-Hui Zhan,

    1. Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, Shandong Province, China
    Search for more papers by this author
  • Ying Sun,

    1. Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, Shandong Province, China
    Search for more papers by this author
  • Shi-Ying Xuan

    Corresponding author
    1. Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, Shandong Province, China
    2. College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, Shandong Province, China
    • Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao 266021, Shandong Province, China===

    Search for more papers by this author
    • fax: +86-532-82836421


  • Potential conflict of interest: Nothing to report.

  • Partially supported by grants from the Natural Science Foundation of Shandong Province, China (No. ZR2009CQ031).

Abstract

The aspartate aminotransferase-to-platelet ratio index (APRI), a tool with limited expense and widespread availability, is a promising noninvasive alternative to liver biopsy for detecting hepatic fibrosis. The objective of this study was to update the 2007 meta-analysis to systematically assess the accuracy of APRI in predicting significant fibrosis, severe fibrosis, and cirrhosis stage in hepatitis C virus (HCV) monoinfected and HCV / human immunodeficiency virus (HIV) coinfected individuals. Studies comparing APRI versus biopsy in HCV patients were identified via a thorough literature search. Areas under summary receiver operating characteristic curves (AUROC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to examine the APRI accuracy for the diagnosis of significant fibrosis, severe fibrosis, and cirrhosis. Heterogeneity was explored using meta-regression. Twenty-one additional studies were eligible for the update and, in total, 40 studies were included in this review (n = 8,739). The summary AUROC of the APRI for the diagnosis of significant fibrosis, severe fibrosis, and cirrhosis were 0.77, 0.80, and 0.83, respectively. For significant fibrosis, an APRI threshold of 0.7 was 77% sensitive and 72% specific. For severe fibrosis, a threshold of 1.0 was 61% sensitive and 64% specific. For cirrhosis, a threshold of 1.0 was 76% sensitive and 72% specific. Moreover, we found that the APRI was less accurate for the identification of significant fibrosis, severe fibrosis, and cirrhosis in HIV/HCV coinfected patients. Conclusion: Our large meta-analysis suggests that APRI can identify hepatitis C-related fibrosis with a moderate degree of accuracy. Application of this index may decrease the need for staging liver biopsy specimens among chronic hepatitis C patients. (HEPATOLOGY 2011)

Ancillary