Platelet count as a predictor of advanced-stage liver cirrhosis: a comparative study with established fibrosis markers

Liver disease remains a major critical challenge in Thailand due to viral hepatitis. Clinical management requires close monitoring of liver fibrosis severity. Non-invasive testing is an attractive method for probing of disease progression. Mac-2 binding protein glycosylation isomer (M2BPGi) is a novel serum marker for fibrosis staging. The current study evaluates the marker among healthy donors and hepatitis C (HCV) patients. 100 HCV subjects were evaluated by liver biopsy. These patients had varying fibrosis severity based on METAVIR scores. Healthy donors were confirmed based on normal liver functions tests. Comparisons of M2BPGi levels among different study groups were performed and the effectiveness was evaluated using receiver operating characteristics (ROC) curves. Using liver biopsy as the reference standard, median M2BPGi levels in HCV cases were 0.74, 1.38 and 2.88 COI for F0-1, F2 and > F3 cases respectively. In healthy donors, the baseline values ranged 0.1–0.24 COI and statistically lower than liver disease cases profiled using M2BPGi. ROC analysis demonstrated superior results for M2BPGi levels among diseased populations and healthy controls. AUROC was determined at 0.983. Comparing with other non-invasive tests, M2BPGi showed a positive linear trend that indicated a strong match to existing methodologies. M2BPGi addresses a critical need in the management of liver disease by providing straightforward means to probe fibrosis severity. In this study, we found significant differences between hepatitis C and healthy subjects and established the background level in healthy donors.

Introduction: Staging of liver fibrosis is essential for making therapeutic decisions in patients with Chronic Hepatitis B (CHB) having raised Hepatitis B Virus Deoxyribonucleic Acid (HBV DNA) levels (>2000 IU/ml) and normal or mildly elevated Alanine Transaminase (ALT). Though the gold standard for assessment of liver fibrosis has been liver biopsy, many non invasive models have been developed to mitigate the risks associated with liver biopsy and overcome its limitations. Aim: To evaluate the non invasive models predictive of significant fibrosis in this selected subgroup of Chronic Hepatitis B patients. Materials and Methods: Fifty-six CHB patients were evaluated. This longitudinal observational study was conducted at Sir Sunderlal Hospital, Institute of Medical Sciences, Banaras Hindu University from February 2017 to July 2018 on 56 patients. Liver Stiffness Measurement (LSM), Aspartate Aminotransferase (AST) to Platelet Ratio Index (APRI), FIBROSIS-4 (FIB-4) and Gamma-Glutamyl Transpeptidase (GGT) to platelet ratio (GPR) were estimated. Liver fibrosis staging was done using Metavir score. Significant fibrosis corresponds to Metavir score F2-F4 and advanced fibrosis as more than F3.The performance of non invasive methods was assessed using Receiver Operating Characteristic (ROC) curves. Z -test was used to compare Area Under ROC Curves (AUROCs). Results: Twenty-one patients (37.5%) had significant fibrosis, out of which seven had F3-F4 fibrosis. Patients with F2-F4 fibrosis had higher age, Hepatitis B e antigen (HBeAg) positivity, HBV DNA, ALT, AST, GGT, LSM, APRI, FIB-4 and GPR values than patients with F0-F1 fibrosis. Metavir fibrosis stages positively correlated with LSM values (r=0.831, p<0.0001), APRI (r=0.338, p=0.011), FIB-4 (r=0.375, p=0.003) and GPR (r=0.36, p=0.012). To predict advanced fibrosis, the AUROC of LSM had higher AUROC than APRI (0.956 vs 0.755, p=0.01), FIB-4 (0.956vs 0.786, p=0.01) and was comparable to GPR (0.956 vs 0.895, p=0.2). Conclusion: Transient Elastography (TE) is a reliable non invasive test for the diagnosis of liver fibrosis. GPR is a new model which is comparable to APRI and FIB-4 but inferior to TE.

The aim of this study was to evaluate the usefulness of the Mac-2 binding protein glycosylation isomer (M2BPGi) for the prediction of posthepatectomy liver failure (PHLF) in hepatocellular carcinoma (HCC) patients. M2BPGi is a novel serum marker of liver fibrosis. The usefulness of M2BPGi for the prediction of PHLF has not been evaluated. Clinicopathological data were analyzed in 138 HCC patients who underwent liver resection between August 2011 and November 2014. PHLF was evaluated according to the definition of the International Study Group of Liver Surgery. Performance of preoperative parameters in predicting PHLF was determined using receiver operating characteristic (ROC) analysis. Serum M2BPGi level correlated with the METAVIR fibrosis score. M2BPGi levels of hepatitis C virus (HCV)-positive patients were significantly higher than those of HCV-negative patients, even in the same fibrosis stage. PHLF ≥ Grade B developed in 19 patients (13.8%). The area under the ROC curve (AUROC) of M2BPGi for the prediction of PHLF ≥ Grade B was 0.71. In multivariate analysis, M2BPGi [odds ratio (OR): 2.08, 95% confidence interval (CI) 1.28-3.55], platelet count (OR: 0.39, 95% CI 0.18-0.80), and resection rate (OR: 2.71, 95% CI 1.46-5.40) were the significant factors associated with PHLF ≥ Grade B. The AUROC of the PHLF index defined by these factors was 0.81. Notably, in patients with HCV infection, the predictive ability of M2BPGi for PHLF (AUROC 0.85) was the best among the preoperative parameters. M2BPGi is a useful predictor of PHLF, especially in patients with HCV infection.

Dear Editor, In patients with chronic liver disease (CLD), liver biopsy is currently an indispensable reference method to assess inflammatory activity and fibrosis stage and thus to estimate prognosis and guide management decisions in such patients. Given that the presence of advanced fibrosis is a predictor of nonresponse, the decision [1] to begin antiviral therapy in cases of chronic viral hepatitis is highly influenced by the stage of liver fibrosis. For example, in chronic hepatitis C (CHC) patients, the stage of liver fibrosis is a predictor of response to interferon-based treatment. Despite these premises, liver biopsy has several disadvantages, including poor patient compliance, sampling error, limited usefulness for follow up, and poor intra- and interobservation agreements [2]. Considering these limitations, in the last decade clinical investigators have been searching for noninvasive methods to obtain accurate information about the fibrosis stage in patients with CLD. Accordingly, a noninvasive diagnostic test for liver fibrosis should be simple, available to wide audiences at limited expense, able to accurately identify disease stage, and sensitive enough to track changes in fibrosis induced by the natural course of disease progression or by therapy [3]. Serum biochemical tests, including direct and indirect markers of liver fibrosis, have been the subject of an intensive investigation, but their diagnostic accuracy has been reported to vary widely [3][4]. In this area, of great contemporary interest is the article by Yilmaz et al. on the usefulness of the aspartate transaminase to platelet ratio index (APRI) to assess liver fibrosis in patients with CLD [5]. APRI is a simple and cheap method to ascertain the ratio between AST and platelets and is easy to use in clinical practice. In patients with CHC, APRI performance has been reported to vary widely in diagnostic accuracy (sensitivities between 41% and 91% and specificities between 47% and 95%) for identifying significant fibrosis. A recent systematic review [6] showed that for significant fibrosis, an APRI threshold of 0.5 was 81% sensitive and 50% specific. Furthermore, Cheung et al. found that in patients with CHC, APRI was better in predicting advanced versus significant fibrosis, and the authors suggested that APRIs with a cutoff of 0.5 and 1.5 can be used in routine clinical practice to exclude or identify the presence of advanced fibrosis [7]. Consistent with the previous research, the retrospective study by Yilmaz et al.[5] showed that APRI has an acceptable accuracy for the assessment of liver fibrosis in patients with CHC but not in those with chronic hepatitis B (CHB). Indeed, in Yilmaz et al.'s study APRI was significantly associated with fibrosis scores in subjects with CHC (p = 0.0059) but not in those with CHB (p = 0.1495). The major finding of their study was that the APRI also had an acceptable accuracy for the assessment of liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD), tending to increase with the degree of fibrosis. In previous observational studies that included patients with NAFLD, the APRI score seldom reached the value of 1 but tended to be higher in patients with advanced stages of fibrosis [8]. In the early stages of NAFLD, patients usually present mild to moderate increases in aminotransferase levels, while platelet counts are usually normal. Fibrosis progresses over time, but it may remain stable for some years. Thus, the focus of the study by Yilmaz et al.[5] is that the APRI may be a useful asset in clinical practice to identify the natural course of NAFLD as it approaches the advanced stages. Nonetheless, much more information is needed on the potential uses of this index in the field of hepatology. More advanced stages of NAFLD appear to be associated with older age, higher BMI, diabetes, hypertension, high triglycerides, and insulin resistance [9]. The findings from different studies are not completely consistent as to which factors (including APRI score) are independently associated with fibrosis progression, and this may depend on the population studied.

Background and AimFibrotic stage (FS) assessment is essential in chronic hepatitis C treatment cascade. Liver stiffness measurement (LSM) using transient elastography (TE) is reliable and correlated with liver biopsy. However, TE may not be widely available. This study aimed to evaluate the diagnostic performances of aspartate aminotransferase to platelet ratio index (APRI) and fibrosis 4 (FIB‐4) scores compared with TE.MethodsWe conducted a multicenter, cross‐sectional study, including all chronic hepatitis C virus (HCV) monoinfection patients with successful and reliable LSM, at 10 centers in Thailand from 2012 to 2017. Characteristics and laboratory data within 3 months of TE were retrospectively reviewed. Using TE as a reference standard, the diagnostic performances of APRI and FIB‐4 were evaluated. TE cut‐off levels of 7.1 and 12.5 kPa represented significant fibrosis (SF) and cirrhosis, respectively.ResultsThe distribution of FS by TE in 2000 eligible patients was as follows: no SF 28.3%, SF 31.4%, and cirrhosis 40.3%. APRI ≥ 1 provided 70.1% sensitivity and 80.6% specificity, with an area under the receiver operator characteristics curve (AUROC) of 0.834 for cirrhosis. The specificity increased to 96.3% when using a cut‐off level of APRI ≥ 2. FIB‐4 ≥ 1.45 provided a sensitivity, specificity, and AUROC of 52.4%, 91.0%, and 0.829 for cirrhosis, respectively. For SF, APRI performed better than FIB‐4, with an AUROC of 0.84 versus 0.80 (P < 0.001). APRI score < 0.5 and FIB‐4 score > 1.45 yielded sensitivities of 82.3% and 74.4% and specificities of 65.4% and 69.8%, respectively.ConclusionsAPRI and FIB‐4 scores had good diagnostic performances for FS assessment compared with TE, especially for cirrhosis. APRI may be used as the noninvasive assessment in resource‐limited settings for HCV patients’ management.

Objective To compare FibroTouch, serum hepatic fibrosis index and aspartate aminotransferase-to-platelet ratio index (APRI) in diagnosis of liver fibrosis and early cirrhosis for patients with chronic HBV infection with mild abnormal liver function. Methods One hundred and seven chronic HBV infected patients with alanine transaminase (ALT) ≤80 U/L who underwent liver biopsy in Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2014 to January 2017 were enrolled in the study. According to the liver biopsy pathology, the patients were divided into mild liver fibrosis group (S1, n=26), significant fibrosis group (S2-3, n=34) and early cirrhosis group (S4, n=47). The differentiations of liver stiffness measurement (LSM), Laminin(LN), Collagen Type Ⅲ N-peptide(PⅢP N-P), Collagen Type IV(CⅣ), Hyaluronic acid (HA) and APRI were compared among the three groups, and their correlations with fibrosis were analyzed with Spearman rank correlation analysis. Logistic regression analysis was performed to establish a multi-index model for predicting the degree of liver fibrosis, and the receiver operating characteristic (ROC) curves were drawn to compare and analyze the predictive value for different stages of liver fibrosis. Results The LSM in the significant fibrosis group was higher than that in the mild liver fibrosis group (Z=-2.611, P 0.05). The prediction of liver fibrosis models were established with Logistic regression analysis. The model 1 Logit (P)=-3.810+ 0.385×LSM+ 0.052×CIV was used for predicting liver fibrosis S≥2; the area under the receiver operating characteristic curve (AUC) was 0.839, with specificity of 96.0%, and the diagnostic efficacy was superior to PⅢP N-P, CⅣ and APRI(Z=2.579, 2.145 and 2.219, all P 0.05). The model 2 Logit (P)=-4.291+ 0.105×LSM+ 0.028×CIV+ 2.682×APRI was used for predicting liver fibrosis S=4; its AUC was 0.865 with sensitivity of 82.9% and specificity of 81.8%, and the diagnostic efficacy was superior to LSM, PⅢP N-P, CⅣ and APRI (Z=2.309, 2.485, 2.403 and 2.103, all P<0.05). Conclusions For chronic HBV infected patients with mild abnormal liver function, FibroTouch can be selected as a noninvasive method to predict liver fibrosis S≥2. The diagnostic efficacy of the prediction model 2, based on the combination of LSM, CIV and APRI is superior to each single index, which can improve the prediction level of early cirrhosis. Key words: Hepatitis B virus; Liver fibrosis; Diagnosis; Fibro Touch; APRI

PurposeChildhood obesity is associated with nonalcoholic fatty liver disease (NAFLD), and it has become one of the most common causes of childhood chronic liver diseases which significant as a cause of liver related mortality and morbidity in children in the United States. The development of simpler and easier clinical indices for medical practice is needed to identify advanced hepatic fibrosis in childhood NAFLD instead of invasive method like liver biopsy. FibroScan and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) have been proposed as a simple and noninvasive predictor to evaluate hepatic fibrosis in several liver diseases. APRI could be a good alternative to detect pathologic change in childhood NAFLD. The purpose of this study is to validate the efficacy of APRI for assessing hepatic fibrosis in childhood NAFLD based on FibroScan.MethodsThis study included 23 children with NAFLD who underwent FibroScan. Clinical, laboratory and radiological evaluation including APRI was performed. To confirm the result of this study, 6 patients received liver biopsy.ResultsFactors associated with hepatic fibrosis (stiffness measurement >5.9 kPa Fibroscan) were triglyceride, AST, alanine aminotransferase, platelet count, APRI and collagen IV. In multivariate analysis, APRI were correlated with hepatic fibrosis (>5.9 kPa). In receiver operating characteristics curve, APRI of meaningful fibrosis (cutoff value, 0.4669; area under the receiver operating characteristics, 0.875) presented sensitivity of 94%, specificity of 66%, positive predictive value of 94%, and negative predictive value of 64%.ConclusionAPRI might be a noninvasive, simple, and readily available method for medical practice to predict hepatic fibrosis of childhood NAFLD.

Aims Among individuals with type 2 diabetes mellitus (T2DM), the prevalence of metabolic dysfunction‐associated steatotic liver disease (MASLD) is disproportionately high, contributing to increased vulnerability toward cirrhosis and, ultimately, primary liver cancer. Early identification of hepatic fibrosis in such patients is therefore of paramount importance. We aimed to explore clinical determinants of fibrosis in patients with T2DM and MASLD and examine chitinase‐3‐like protein 1 (CHI3L1) as a potential indicator of fibrotic progression. Methods This retrospective study included patients with T2DM who initially visited Tianjin Third Central Hospital (January 2023–August 2024). Liver fibrosis was assessed both across the entire T2DM cohort and among those with coexisting MASLD, based on liver stiffness measurement (LSM) and noninvasive indicators, such as aspartate aminotransferase‐to‐platelet ratio index (APRI), fibrosis‐4 (FIB‐4) index, and CHI3L1. An LSM threshold of 8 kPa was used to identify significant liver fibrosis (SLF). Associations between LSM, CHI3L1, and other indicators were examined by correlation analysis. Risk factors of liver fibrosis were determined by logistic regression analyses, and the discriminative ability of CHI3L1 was evaluated using receiver operating characteristic curve analysis. Results The cohort comprised 236 patients with T2DM, including 176 with concomitant MASLD (74.6%) and 89 with SLF (37.7%). In the T2DM–MASLD group, 74 (42.0%) patients had SLF, with significantly elevated weight, body mass index (BMI), thyroid‐stimulating hormone (TSH), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma‐glutamyl transferase (GGT), lactate dehydrogenase (LDH), total bilirubin (TBIL), direct bilirubin (DBIL), FIB‐4, CHI3L1, APRI, LSM, and controlled attenuation parameter (CAP), and reduced systolic blood pressure (SBP), platelet count (PLT), low‐density lipoprotein cholesterol (LDL‐C), and platelet‐to‐white blood cell ratio (PWR), compared with their fibrosis‐free counterparts (all p &lt; 0.05). A significant positive correlation was observed between CHI3L1 expression and LSM ( r = 0.48, p &lt; 0.001). Multivariate analysis identified CHI3L1 (odds ratio [OR] = 1.84, 95% confidence interval [CI]: 1.209–2.809, p = 0.004), APRI (OR = 2.71, 95% CI: 1.629–4.529, p &lt; 0.001), and CAP (OR = 2.63, 95% CI: 1.612–4.317, p &lt; 0.001) as independent determinants of fibrosis risk. The predictive capacity of CHI3L1 showed an area under the curve (AUC) of 0.717 (95% CI: 0.638–0.796, p &lt; 0.05), corresponding to a cutoff value of 96.6 ng/mL. Conclusion A substantial share of patients with T2DM were diagnosed with MASLD, while some had SLF. Patients with fibrosis had higher BMI, CHI3L1, AST, LDH, TSH, APRI, LSM, and CAP levels than those without. Notably, serum CHI3L1 correlated significantly with fibrosis and may function as a biomarker for disease progression.

Objective To investigate the value of gamma-glutamyl transpeptidase-to-platelet ratio (GPR) in predicting liver fibrosis stage in chronic hepatitis B (CHB) patients in Guangdong, China. Methods A total of 501 patients who were diagnosed with CHB by liver biopsy in Guangzhou 8 th People's Hospital from January 2010 to December 2016 were enrolled, among whom 335 had HBe Ag-positive CHB and 166 had HBe Ag-negative CHB. The value of GPR, gamma-glutamyl transpeptidase (GGT) , aspartate aminotransferase-to-platelet ratio index (APRI) , and fibrosis-4 (FIB-4) in predicting liver fibrosis stage (F1-F4) was analyzed. The Spearman correlation coefficient was used to analyze the correlation between diagnostic models and liver fibrosis stage, and the area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the value of each model in predicting liver fibrosis stage. Results With liver biopsy as the gold standard, of all patients, 141 had F1 stage, 183 had F2 stage, 139 had F3 stage, and 38 had F4 stage disease. The Spearman correlation analysis showed that in HBe Ag-positive and HBe Ag-negative patients, GGT, GPR, APRI, and FIB-4 were positively correlated with liver fibrosis stage (r = 0. 459, 0. 526, 0. 320, 0. 470, 0. 272, 0. 366, 0. 288, and 0. 388, all P 0. 05) ; in HBe Ag-negative CHB patients, GPR had a significantly better value in predicting marked fibrosis (≥F2) than GGT and APRI (both P 0. 05) . Conclusion GPR can be used as a noninvasive biochemical index for liver fibrosis stage in CHB patients in Guangdong, and in HBe Ag-positive CHB patients, GPR has a comparable predictive value to FIB-4 and APRI.

Background: Many noninvasive methods, including aspartate amino transaminase (AST)/alanine amino transaminase (ALT) ratio (AAR), AST-to-platelet ratio index (APRI), Bonacini cirrhosis discriminant score (CDS), fibrosis-4 (FIB4) index, and age-platelet index (API), have been described to determine the stage of hepatic fibrosis. However, these methods are developed for patients with chronic hepatitis C (CHC) and produce conflicting results in the prediction of liver fibrosis in patients with chronic hepatitis B (CHB). Objectives: The aim of this study was to evaluate the relationship between 7 noninvasive models, including AAR, APRI, CDS, API, FIB-4, neutrophil-to-lymphocyte ratio (NLR), and red cell distribution width (RDW)-to-platelet ratio (RPR) in patients with CHB. Methods: The study population included all patients with CHB, undergoing liver biopsy to determine HBsAg and HBV DNA positivity in more than 6 months. Results: A total of 2520 treatment-naive CHB patients from 40 different centers were included in the study. In total, 62.6% of the patients were male, and the mean age was 40.60 ± 12.34 years (minimum, 18 years; maximum, 77 years). The Ishak fibrosis score was ≥ 3 in 29.8% of the patients, indicating significant fibrosis. The mean API, APRI, CDS, NLR, FIB4, and RPR scores in the noninvasive models were significantly different between the groups with significant and low fibrosis (P < 0.05). All the noninvasive models (API, APRI, AAR, CDS, NLR, RPR, and FIB4) were found to be significant in the discrimination of cirrhosis (P < 0.05). In the multiple logistic regression analysis, CDS, albumin, alkaline phosphatase (ALP), total bilirubin, neutrophil count, NLR, mean platelet volume (MPV), and FIB4 were independent indices for cirrhosis. Conclusions: In the present study, the role of noninvasive tests in the prediction of liver fibrosis stage and cirrhosis was evaluated in a large cohort of CHB patients. Overall, noninvasive models are gradually becoming more promising. Accordingly, the need for liver biopsy can be reduced with a combination of noninvasive methods in the future.

Hepatic fibrosis is a common pathological basis for many chronic liver diseases and can progress to cirrhosis, a leading cause of mortality in liver diseases. Early identification and reversal of hepatic fibrosis are key in the treatment of chronic liver disease. This study aims to compare the expression levels of serum core fucosylated low molecular weight kininogen (LMWK-Fc) and alpha-galactosylated (α-Gal) antibodies in patients with hepatic fibrosis at different stages, and to evaluate their diagnostic efficacy for hepatic fibrosis. A retrospective analysis was conducted on 275 patients with chronic liver disease who visited the Department of Infectious Diseases at the Second Xiangya Hospital of Central South University between June 2022 and March 2023. Among these, 115 patients underwent liver biopsy. Based on the extent of collagen deposition and its impact on liver structure and microcirculation, patients were staged from 0 to 4: S0 (no significant collagen deposition in liver tissues; liver structure and microcirculation are normal), S1 (mild collagen deposition in liver tissues, with partial disruption of lobule structure, but microcirculation remains largely normal), S2 (moderate collagen deposition in liver tissues, with partial disruption of lobule structure and microcirculation), S3 (extensive collagen deposition in liver tissues, with substantial disruption of lobule structure and microcirculation), and S4 (development of cirrhosis, with heavy collagen deposition, complete disruption of lobule structure, and severe impairment of microcirculation). Patients were grouped as no fibrosis (S0), fibrosis (S1-S2), and significant fibrosis (S3-S4). For the 160 patients without liver biopsy, they were categorized based on liver stiffness measurement (LSM) value: no fibrosis (F0: LSM<7.3 kPa), fibrosis (F1-F2: LSM 7.3-12.4 kPa), and significant fibrosis (F3-F4: LSM>12.4 kPa). Demographic data (age, gender) and laboratory indicators (alanine transaminase, aspartate transaminase, gamma-glutamyl transferase, alkaline phosphatase, alpha-fetoprotein, platelet count) were collected to calculate the fibrosis-4 index (FIB-4) and aspartate aminotransferase-to-platelet ratio index (APRI). Serum LMWK-Fc and α-Gal antibodies were measured and compared across the groups, and their correlation with fibrosis severity was analyzed. The receiver operating characteristic (ROC) curve was used to assess the predictive value of serum LMWK-Fc and α-Gal antibody levels for hepatic fibrosis. Among the 160 patients without complete liver biopsy, serum α-Gal antibody and LMWK-Fc levels increased progressively from the no fibrosis group to the significant fibrosis group, with statistically significant differences (P<0.05). Among the 115 patients with liver biopsy, serum LMWK-Fc levels were significantly higher in the fibrosis group and the significant fibrosis groups compared with the no fibrosis group, and α-Gal antibody levels were significantly higher in the significant fibrosis group compared with the no fibrosis group and the fibrosis group (P<0.001, P=0.032, respectively). Univariate and multivariate linear regression analyses showed that hepatic fibrosis was correlated with gender and LMWK-Fc levels (both P<0.05), but not with age, α-Gal antibody levels, FIB-4, or APRI (all P>0.05). The expression levels of serum LMWK-Fc and α-Gal antibodies vary across different stages of hepatic fibrosis, suggesting a potential association with fibrosis progression. LMWK-Fc levels have a certain predictive value for the diagnosis of hepatic fibrosis.

Chronic Hepatitis C Virus (HCV) infection leads to progressive fibrosis making fibrosis staging necessary in the evaluation of such patients. Different fibrosis scores are emerging as possible non-invasive alternatives for liver biopsy. The Fibrosis-4 Index (FIB-4) and AST to Platelet Ratio Index (APRI) scores are the most widely used and the most extensively tested. This study aims to determine if it was possible to accurately use these to identify patients that are unlikely to have severe fibrosis. One hundred and forty-two patients with chronic hepatitis C infection who underwent liver biopsy since January 1st 2014 until May 31st 2017 at the Hospital for Infectious and Tropical Diseases in Belgrade were analyzed. The FIB-4 and APRI scores were calculated for each patient and compared to histologically determined fibrosis stage. A comprehensive statistical analysis was conducted in order to compare patients with and without severe fibrosis and to evaluate the accuracy of the fibrosis scores. Patients with non-severe fibrosis were younger, had higher platelet counts and lower transaminase levels. FIB-4 had an AUC of 0.875 and the APRI score had an AUC of 0.861. No patients with severe fibrosis or cirrhosis had a FIB-4 lower than 1.08. FIB-4 was superior to APRI in identifying patients with severe fibrosis in the study cohort. FIB-4 was superior to APRI in the recognition of severe fibrosis. FIB-4 may prove very useful in identifying patients without advanced liver disease, especially if other non-invasive methods are inaccessible.

A total of 350 million individuals are affected by chronic hepatitis B virus infection world-wide. Historically, liver biopsy has been instrumental in adequately assessing patients with chronic liver disease. A number of non-invasive models have been studied world-wide. The aim of this study is to assess the utility of non-invasive mathematical models of liver fibrosis in chronic hepatitis B (CHB). Indian patients in a resource limited setting using routinely performed non-invasive laboratory investigations. A cross-sectional study carried out at a tertiary care center. A total of 52 consecutive chronic liver disease patients who underwent percutaneous liver biopsy and 25 healthy controls were enrolled in the study. Routine laboratory investigations included serum aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Gama glutamyl transpeptidase (GGT), total bilirubin, total cholesterol, prothrombin time and platelet count. Three non-invasive models for namely aspartate aminotransferase to platelet ratio index (APRI), Fibrosis 4 (FIB-4) and Forn's index were calculated. Outcomes were compared for the assessment of best predictor of fibrosis by calculating the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each index. Medcalc online software and by Microsoft Excel Worksheet. Chi-square test was used for significance. P value < 0.05 was taken as significant. While the serum levels of AST, ALT and GGT were significantly higher in patients group as compare with the healthy controls (P < 0.01), the platelet counts were significantly lower in patient group as compared to the control group (P < 0.01). Mean value of all 3 indices were significantly higher in patients group as compare with the controls (P < 0.01). Out of the three indices, APRI index with a NPV of 95% appeared to be a better model for excluding significant liver fibrosis while FIB-4 with a PPV of 61% showed fair correlation with significant fibrosis. Thus, these two non-invasive models for predicting of liver fibrosis, namely APRI and FIB-4, can be utilized in combination as screening tools in monitoring of CHB patients, especially in resource limiting settings.

Expert consensus on clinical usefulness of M2BPGi for managing chronic liver diseases.

ABSTRACTChronic hepatitis C virus (HCV) infection is a major cause of liver cirrhosis and hepatocellular carcinoma, which may lead to liver transplantation. Co-infection with HIV may accelerate liver disease and impact treatment response. Monitoring liver fibrosis involves non-invasive methods such as transient hepatic elastography (THE), AST to Platelet Ratio Index (APRI), and Fibrosis-4 (FIB-4). This study compared changes in THE, APRI, and FIB-4 among patients with HCV alone and those with HIV-HCV co-infection before and after direct-acting antiviral (DAA) therapy. We conducted a retrospective cohort study using medical records from patients treated at a reference clinic in Sao Paulo, Brazil, between January 2015 and February 2019. Fibrosis assessments (THE, APRI, FIB-4) were performed pre-treatment and six months post-treatment. APRI and FIB-4 were also evaluated at 12 months. Among 148 participants, 105 (70%) had HCV mono-infection and 43 (30%) had HIV-HCV co-infection. Genotype 1 was most prevalent (86%). At six months post-treatment, greater reductions in THE, APRI, and FIB-4 were observed in the HCV mono-infection group. Pre-treatment THE values positively correlated with subsequent reductions. However, multivariable analysis showed no significant differences between groups in THE reductions, and no significant group differences in APRI or FIB-4 at six and 12 months. DAA treatment led to fibrosis regression in most participants. HIV co-infection did not significantly alter fibrosis outcomes following successful HCV treatment.