Optimization of the Use of APRI and FIB-4 for Ruling Out Liver Cirrhosis in Chronic Hepatitis B Patients With Normal Alanine Aminotransferase

IF 2.5 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Zhiyi Zhang, Jian Wang, Li Zhu, Yiguang Li, Shaoqiu Zhang, Yifan Pan, Yuxin Chen, Shengxia Yin, Xiaomin Yan, Xingxiang Liu, Yuanwang Qiu, Chao Wu, Jie Li, Chuanwu Zhu, Rui Huang
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Abstract

The exclusion of cirrhosis is important in chronic hepatitis B (CHB) patients with normal alanine aminotransferase (ALT). We aimed to optimise the performance of the aspartate aminotransferase to platelet ratio index (APRI) and fibrosis score based on four factors (FIB-4) to exclude cirrhosis in these patients. Five hundred and eighty four patients with normal ALT who underwent liver biopsy were included in the study. The patients were divided into derivation and external validation sets. A grid search method was used to identify new cut-offs with a negative predictive value (NPV) of > 95% and a sensitivity of > 90% for detecting cirrhosis. The proportion of patients with cirrhosis in the derivation and validation sets was 19.4% and 7.5%, respectively. The conventional cut-offs of APRI (77.6%) and FIB-4 (41.8%) had high rates of cirrhosis misclassification. A new APRI cut-off of 0.21 had a sensitivity of 97.0% and an NPV of 95.6%, and only two (3.0%) patients with cirrhosis were misclassified in the derivation set. Using a new FIB-4 cut-off of 0.53, with a sensitivity of 98.5% and NPV of 96.2%, only one (1.5%) patient with cirrhosis was misclassified. External validation showed similar results. Using the new cut-offs of APRI and FIB-4, cirrhosis could be completely excluded for HBeAg-positive patients or those aged > 40 years. The conventional cut-offs had high misclassification rates for cirrhosis. The new cut-offs of APRI (≤ 0.21) and FIB-4 (≤ 0.53) could be used to exclude cirrhosis in CHB patients with normal ALT levels with a low misclassification rate.

丙氨酸转氨酶正常的慢性乙型肝炎患者应用APRI和FIB-4排除肝硬化的优化
对于丙氨酸氨基转移酶(ALT)正常的慢性乙型肝炎(CHB)患者来说,排除肝硬化非常重要。我们旨在优化天冬氨酸氨基转移酶与血小板比值指数(APRI)和基于四个因子的纤维化评分(FIB-4)的性能,以排除这些患者的肝硬化。研究共纳入了 584 名 ALT 正常并接受了肝活检的患者。这些患者被分为推导集和外部验证集。采用网格搜索法找出检测肝硬化的阴性预测值(NPV)大于 95%、灵敏度大于 90% 的新临界值。推导集和验证集中肝硬化患者的比例分别为 19.4% 和 7.5%。传统的 APRI 临界值(77.6%)和 FIB-4 临界值(41.8%)的肝硬化误诊率较高。新的 APRI 临界值为 0.21,灵敏度为 97.0%,NPV 为 95.6%,衍生集中只有两名(3.0%)肝硬化患者被误诊。使用新的 FIB-4 临界值 0.53,灵敏度为 98.5%,净现值为 96.2%,只有一名(1.5%)肝硬化患者被误诊。外部验证也显示了类似的结果。使用 APRI 和 FIB-4 的新临界值,可以完全排除 HBeAg 阳性或年龄大于 40 岁的肝硬化患者。传统的临界值对肝硬化的误判率很高。新的临界值 APRI(≤ 0.21)和 FIB-4(≤ 0.53)可用于排除 ALT 水平正常的慢性乙型肝炎患者的肝硬化,且误判率较低。
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来源期刊
Journal of Viral Hepatitis
Journal of Viral Hepatitis 医学-病毒学
CiteScore
6.00
自引率
8.00%
发文量
138
审稿时长
1.5 months
期刊介绍: The Journal of Viral Hepatitis publishes reviews, original work (full papers) and short, rapid communications in the area of viral hepatitis. It solicits these articles from epidemiologists, clinicians, pathologists, virologists and specialists in transfusion medicine working in the field, thereby bringing together in a single journal the important issues in this expanding speciality. The Journal of Viral Hepatitis is a monthly journal, publishing reviews, original work (full papers) and short rapid communications in the area of viral hepatitis. It brings together in a single journal important issues in this rapidly expanding speciality including articles from: virologists; epidemiologists; clinicians; pathologists; specialists in transfusion medicine.
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