What question did this study set out to answer?

To evaluate the diagnostic efficacy of modified APRI cutoffs for identifying significant liver fibrosis in HIV/HCV co-infected patients.

March 12, 2008

Optimized cutoffs improve performance of the aspartate aminotransferase to platelet ratio index for predicting significant liver fibrosis in human immunodeficiency virus/hepatitis C virus co‐infection

Key Points

To evaluate the diagnostic efficacy of modified APRI cutoffs for identifying significant liver fibrosis in HIV/HCV co-infected patients.
Conducted a retrospective cross-sectional study with HIV/HCV co-infected patients undergoing liver biopsy.
Evaluated APRI's diagnostic accuracy by calculating positive and negative predictive values and AUROC.
Included 111 patients, assessing fibrosis using METAVIR scores.
Significant fibrosis was detected in 45 of 111 patients (41%) with an AUROC of 0.774 ± 0.045.
An APRI value of ≥1.8 indicated a PPV of 75% for significant fibrosis.
Using modified APRI cutoffs could avoid 46% of liver biopsies, compared to 40% with traditional cutoffs.

Abstract

AIM: To assess the diagnostic value of modified cutoffs for aspartate aminotransferase to platelet ratio index (APRI) to predict significant liver fibrosis in human immunodeficiency virus (HIV)/hepatitis C virus (HCV) patients. PATIENTS AND METHODS: This retrospective cross-sectional study included consecutive patients with HIV/HCV co-infection who underwent percutaneous liver biopsy. The accuracy of APRI for the diagnosis of significant fibrosis (F2/F3/F4 METAVIR) was evaluated by estimating the positive and negative predictive values (PPV and NPV respectively) and by measuring the area under the receiver operating characteristics curve (AUROC). RESULTS: One hundred and eleven patients were included (73% men, mean age 40.2+/-7.8 years). Significant fibrosis was observed in 45 patients (41%). To discriminate these subjects, the AUROC of APRI was 0.774+/-0.045. An APRI > or = 1.8 showed a PPV of 75% for the presence of significant fibrosis, and an index or = 0.6 and < 1.8), 46% of liver biopsies could have been avoided as compared with 40% using the classical cutoffs. CONCLUSION: APRI with adjusted cutoffs can predict significant liver fibrosis in patients with HIV/HCV co-infection and might obviate the need to perform a biopsy in a considerable percentage of those subjects.

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