title: Aspartate aminotransferase to platelet ratio index as a prospective predictor of hepatocellular carcinoma risk in patients with chronic hepatitis B virus infection.
abstract: OBJECTIVE
  APRI (aspartate aminotransferase [AST] to platelet ratio index) is widely used to assess fibrosis and cirrhosis risk, especially in hepatitis C virus (HCV)-infected patients. Few studies have evaluated APRI and hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) risk. Prospective evidence is needed to assess whether APRI predicts HCC risk in HBV patients.
  
  
  METHODS
  In a prospectively enrolled clinical cohort of 855 HBV patients with a 1-year exclusion window (followed for > 1 year and did not develop HCC within 1 year), the predictive value of APRI in HCC risk was evaluated by Cox proportional hazards model using univariate and multivariate analyses and longitudinal analysis.
  
  
  RESULTS
  Higher APRI prospectively conferred a significantly increased risk of HCC in univariate analysis (quartile analysis, P trend = 2.9 × 10(-7) ). This effect remained highly significant after adjusting for common host characteristics but not cirrhosis (P trend = 7.1 × 10(-5) ), and attenuated when cirrhosis is adjusted (P trend = 0.021). The effect remained prominent when the analysis was restricted to patients with a more stringent 2-year exclusion window (P trend = 0.008 in quartile analysis adjusting all characteristics including cirrhosis), indicating that the association was unlikely due to including undetected HCC patients in the cohort, thus minimizing the reverse-causation limitation in most retrospective studies. Longitudinal comparison demonstrated a persistently higher APRI value in HBV patients who developed HCC during follow-up than those remaining cancer free.
  
  
  CONCLUSIONS
  APRI might be a marker of HCC risk in HBV patients in cirrhosis-dependent and -independent manners. Further studies are warranted to validate this finding and test its clinical applicability in HCC prevention.
authors.affiliation: Liver Disease Prevention Center, Division of Gastroenterology and Hepatology, Department of Medicine.
authors.forename: Hie-Won
authors.initials: HW
authors.lastname: Hann
authors.affiliation: Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.|Institute of Pharmacy, Pharmaceutical College of Henan University, Kaifeng, Henan 475004, China.
authors.forename: Shaogui
authors.initials: S
authors.lastname: Wan
authors.affiliation: Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors.forename: Yinzhi
authors.initials: Y
authors.lastname: Lai
authors.affiliation: Liver Disease Prevention Center, Division of Gastroenterology and Hepatology, Department of Medicine.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hann
authors.affiliation: Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Myers
authors.affiliation: Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors.forename: Fenil
authors.initials: F
authors.lastname: Patel
authors.affiliation: Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors.forename: Kejin
authors.initials: K
authors.lastname: Zhang
authors.affiliation: Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors.forename: Zhong
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors.forename: Chun
authors.initials: C
authors.lastname: Wang
authors.affiliation: Division of Population Science, Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors.forename: Hushan
authors.initials: H
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D015331:Cohort Studies; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010976:Platelet Count; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases
keywords: APRI; HBV; HCC