title: Comparisons of noninvasive indices based on daily practice parameters for predicting liver cirrhosis in chronic hepatitis B and hepatitis C patients in hospital and community populations.
abstract: Several noninvasive indices have been proposed for predicting liver cirrhosis (LC), particularly in chronic hepatitis C (CHC). In this study, noninvasive indices for predicting LC and hepatocellular carcinoma (HCC) were compared. A total of 119 chronic hepatitis B (CHB) patients and 240 CHC patients were evaluated in a hospital-based setting using various predictors for pathologic LC such as aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio (AAR), AAR-to-platelet ratio index (AARPRI), AST-to-platelet ratio index (APRI), age-platelet (AP) index, and platelet counts. In addition, these indices were used to predict LC [based on ultrasound (US)] in a community-based population of 201 patients with endemic hepatitis C virus (HCV). These indices were evaluated for their ability to predict HCC in CHB and CHC patients (n = 200). In CHB patients, the diagnostic performance of all indices was inadequate for predicting LC (areas under receiver operating characteristic curves < 0.7). Thrombocytopenia consistently demonstrated comparable accuracy to AARPRI ≥ 0.7 in CHB and AP index ≥ 7.0 in CHC patients. The best cut-off values for APRI, AARPRI, and AP index in predicting LC in CHC were 1.3, 0.8, and 7.0, respectively. The best cut-off values for APRI, AARPRI, and AP index in predicting LC (based on US) were 1.0, 1.2, and 8.0, respectively, in a HCV endemic community. An AAR > 1.4 might be a useful tool to identify candidates at high risk for HCC. In conclusion, platelet count was both consistent and accurate in predicting LC. An AAR > 1.4 is proposed as a possible surrogate marker for identifying patients at high risk for developing HCC.
authors.affiliation: Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan.
authors.forename: Po-Lin
authors.initials: PL
authors.lastname: Tseng
authors.forename: Jing-Houng
authors.initials: JH
authors.lastname: Wang
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Hung
authors.forename: Hung-Da
authors.initials: HD
authors.lastname: Tung
authors.forename: Tsung-Ming
authors.initials: TM
authors.lastname: Chen
authors.forename: Wu-Shiung
authors.initials: WS
authors.lastname: Huang
authors.forename: Shiann-Long
authors.initials: SL
authors.lastname: Liu
authors.forename: Tsung-Hui
authors.initials: TH
authors.lastname: Hu
authors.forename: Chuan-Mo
authors.initials: CM
authors.lastname: Lee
authors.forename: Sheng-Nan
authors.initials: SN
authors.lastname: Lu
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets / Q000473:pathology*; D005260:Female; D016174:Hepacivirus / Q000302:isolation & purification; D006515:Hepatitis B virus / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D006801:Humans; D007297:Inpatients; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010976:Platelet Count; D011379:Prognosis; D013921:Thrombocytopenia / Q000209:etiology / Q000473:pathology
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase