The ratio of aminotransferase to platelets is a useful index for predicting hepatic fibrosis in hemodialysis patients with chronic hepatitis C.
Percutaneous liver biopsy is the gold standard for staging hepatic fibrosis of hemodialysis patients with chronic hepatitis C before renal transplantation or antiviral therapy. Concerns exist, however, about serious post-biopsy complications. To evaluate a more simple approach using standard laboratory tests to predict hepatic fibrosis and its evolution, we studied 279 consecutive hemodialysis patients with chronic hepatitis C and a baseline biopsy. Among them, 175 receiving antiviral therapy underwent follow-up biopsy to evaluate the histological evolution of fibrosis. Multivariate analysis of routine laboratory tests at baseline showed the aspartate aminotransferase-to-platelet ratio index was an independent predictor of significant hepatic fibrosis. The areas under curves of this ratio to predict fibrosis stages F2-4 were 0.83 and 0.71 in the baseline and follow-up sets; and 0.75 and 0.80 respectively, for patients with sustained or non-sustained virological response groups in the follow-up sets. By a judicious setting of cut-off levels for the baseline and non-sustained groups, and the sustained virological response group, almost half and 60 percent of the baseline and follow-up sets could be correctly diagnosed without biopsy. Our study found the aminotransferase-to-platelet ratio index is accurate and reproducible for assessing hepatic fibrosis in hemodialysis patients with chronic hepatitis C. Applying this simple index could decrease the need of percutaneous liver biopsy in this clinical setting.
Liu
Chen-Hua
CH
Department of Internal Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
Liang
Cheng-Chao
CC
Liu
Chun-Jen
CJ
Hsu
Shih-Jer
SJ
Lin
Jou-Wei
JW
Chen
Shih-I
SI
Hung
Peir-Haur
PH
Tsai
Hung-Bin
HB
Lai
Ming-Yang
MY
Chen
Pei-Jer
PJ
Chen
Jun-Herng
JH
Chen
Ding-Shinn
DS
Kao
Jia-Horng
JH
D000328:Adult; D001219:Aspartate Aminotransferases; D001706:Biopsy / Q000009:adverse effects; D001707:Biopsy, Needle / Q000009:adverse effects; D001792:Blood Platelets / Q000473:pathology; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D006435:Renal Dialysis / Q000009:adverse effects; D000637:Transaminases
D000637:Transaminases; D001219:Aspartate Aminotransferases