title: Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Medical College of Qingdao University, Qingdao, Shandong Province, China.
authors.forename: Zhong-Hua
authors.initials: ZH
authors.lastname: Lin
authors.forename: Yong-Ning
authors.initials: YN
authors.lastname: Xin
authors.forename: Quan-Jiang
authors.initials: QJ
authors.lastname: Dong
authors.forename: Qing
authors.initials: Q
authors.lastname: Wang
authors.forename: Xiang-Jun
authors.initials: XJ
authors.lastname: Jiang
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Zhan
authors.forename: Ying
authors.initials: Y
authors.lastname: Sun
authors.forename: Shi-Ying
authors.initials: SY
authors.lastname: Xuan
mesh_terms: D000328:Adult; D001219:Aspartate Aminotransferases / Q000032:analysis*; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases