Aspartate aminotransferase to platelet ratio index in patients with alcoholic liver fibrosis.
OBJECTIVE
Aspartate aminotransferase (AST) to platelet ratio index (APRI) has been proposed as an easily determined and accurate noninvasive marker of liver fibrosis in chronic hepatitis C. To validate APRI in hepatitis C and to determine its usefulness in other liver diseases, we evaluated APRI in patients with liver fibrosis due to excessive alcohol consumption with or without viral hepatitis C.


METHODS
A total of 1,308 subjects from two VA cooperative studies of alcoholic liver disease were evaluated. Liver biopsy was available from 781 noncirrhotic patients while a history of decompensation was present in 527. Alcohol intake was determined by self-report. Hepatitis C was confirmed by PCR.


RESULTS
Ninety-eight percent were men with a mean age of 51.5 yr. Alcohol intake averaged 19 drinks/day for 20.6 yr. One hundred thirty-three (10.2%) were hepatitis C positive. In the HCV-positive subgroup, APRI had a sensitivity of 35.6% and a specificity of 29.7% for significant fibrosis. Of 64 patients classified as significant fibrosis, 21 (32.8%) were incorrectly classified. In the 507 HCV negative patients with biopsy confirmed fibrosis, the sensitivity of APRI for significant fibrosis was 13.2% and the specificity was 77.6%. Twenty percent were classified incorrectly.


CONCLUSIONS
APRI has low sensitivity and specificity for the diagnosis of significant fibrosis in patients with alcoholic liver disease, including patients who have hepatitis C. Given the frequent history of alcohol use in patients with hepatitis C, APRI may be of limited usefulness in the diagnosis of fibrosis in many patients.
Lieber
Charles S
CS
James J. Peters Veterans Affairs Medical Center, Alcohol Research and Treatment Center, Liver Diseases and Nutrition Section, Bronx, New York 10468, USA.
Weiss
David G
DG
Morgan
Timothy R
TR
Paronetto
Fiorenzo
F
D001219:Aspartate Aminotransferases / Q000097:blood*; D016009:Chi-Square Distribution; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005355:Fibrosis / Q000097:blood / Q000201:enzymology; D019698:Hepatitis C, Chronic / Q000473:pathology; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000097:blood* / Q000201:enzymology / Q000473:pathology; D008111:Liver Function Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012372:ROC Curve
D001219:Aspartate Aminotransferases