title: The ratio of aminotransferase to platelets is a useful index for predicting hepatic fibrosis in hemodialysis patients with chronic hepatitis C.
abstract: 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.
authors.affiliation: Department of Internal Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chen-Hua
authors.initials: CH
authors.lastname: Liu
authors.forename: Cheng-Chao
authors.initials: CC
authors.lastname: Liang
authors.forename: Chun-Jen
authors.initials: CJ
authors.lastname: Liu
authors.forename: Shih-Jer
authors.initials: SJ
authors.lastname: Hsu
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
authors.forename: Shih-I
authors.initials: SI
authors.lastname: Chen
authors.forename: Peir-Haur
authors.initials: PH
authors.lastname: Hung
authors.forename: Hung-Bin
authors.initials: HB
authors.lastname: Tsai
authors.forename: Ming-Yang
authors.initials: MY
authors.lastname: Lai
authors.forename: Pei-Jer
authors.initials: PJ
authors.lastname: Chen
authors.forename: Jun-Herng
authors.initials: JH
authors.lastname: Chen
authors.forename: Ding-Shinn
authors.initials: DS
authors.lastname: Chen
authors.forename: Jia-Horng
authors.initials: JH
authors.lastname: Kao
mesh_terms: 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
chemical_list: D000637:Transaminases; D001219:Aspartate Aminotransferases