title: Platelet count to spleen diameter ratio non-invasively identifies severe fibrosis and cirrhosis in patients with autoimmune hepatitis.
abstract: OBJECTIVE
  Non-invasive markers are essential to assess the progression of chronic liver diseases to fibrosis/ cirrhosis and the effectiveness of therapeutic strategies. The aim of this study was to evaluate the ability of non-invasive markers to identify significant fibrosis, severe fibrosis, and cirrhosis in patients with autoimmune hepatitis (AIH).
  
  
  METHODS
  Seventy-six patients with AIH were enrolled in the study and analyzed for the following parameters of liver fibrosis: Fibrosis 4 score (FIB-4), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), AST to platelet count ratio (APRI), and platelet count to spleen diameter (PC/SD) ratio. All patients underwent liver biopsy. The diagnostic accuracy of tests was evaluated by the area under the receiver operating characteristic curve (AUROC).
  
  
  RESULTS
  Among the 76 AIH patients, 55 (72.3%) had significant fibrosis (≥ F2), 37 (48.7%) had severe fibrosis (≥ F3), and 29 (38.2%) had cirrhosis (F4). PC/SD ratio (AUROC = 0.840) was superior to AAR (AUROC = 0.756), FIB-4 (AUROC = 0.702), and APRI (AUROC = 0.626) in discriminating between mild and significant fibrosis (≥ F2). The AUROCs of PC/SD ratio, FIB-4, AAR, and APRI were 0.884, 0.742, 0.731, and 0.707, respectively, for severe fibrosis (≥ F3); 0.968, 0.795, 0.744, and 0.723, respectively, for cirrhosis (F4). PC/SD ratio correctly identified 85.1% of patients with severe fibrosis, and 89.6% of patients with cirrhosis.
  
  
  CONCLUSIONS
  PC/SD ratio proved to be a simple non-invasive tool to correctly identify AIH patients with severe fibrosis and cirrhosis, thereby reducing the need for a liver biopsy in these patients.
authors.affiliation: Department of Hepatology, V.H. Vasilenko Clinic of Internal Diseases, Gastroenterology and Hepatology, First Moscow State Medical University n.a. I.M. Sechenov, Moscow, Russian Federation.
authors.forename: Anna
authors.initials: A
authors.lastname: Sheptulina
authors.affiliation: Department of Hepatology, V.H. Vasilenko Clinic of Internal Diseases, Gastroenterology and Hepatology, First Moscow State Medical University n.a. I.M. Sechenov, Moscow, Russian Federation.
authors.forename: Elena
authors.initials: E
authors.lastname: Shirokova
authors.affiliation: Department of Pathology, First Moscow State Medical University n.a. I.M. Sechenov, Moscow, Russian Federation.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Nekrasova
authors.affiliation: Clinic of Medicine II, University Medical Center, Freiburg, Germany.
authors.forename: Hubert
authors.initials: H
authors.lastname: Blum
authors.affiliation: Department of Hepatology, V.H. Vasilenko Clinic of Internal Diseases, Gastroenterology and Hepatology, First Moscow State Medical University n.a. I.M. Sechenov, Moscow, Russian Federation.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Ivashkin
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001792:Blood Platelets; D016208:Databases, Factual; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013154:Spleen / Q000000981:diagnostic imaging*; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: autoimmune hepatitis; biopsy; liver fibrosis; non-invasive