Diagnosis of non-invasive cirrhosis with HBV_APRI score

Http://www.hepatitisc.uw.edu/page/clinical-calculators/apriInterpretation:

Apri individual data does not adequately explain cirrhosis, but also requires reference to fibrotest data

In a meta-analysis of studies, investigators concluded this an APRI score greater than 1.0 had a sensitivity of 76% and Specificity of 72% for predicting cirrhosis. In addition, they concluded it APRI score greater than 0.7 had a sensitivity of 77% and specificity of 72% for Predictin G Significant hepatic fibrosis.1

For detection of cirrhosis, the using an APRI cutoff score of 2.0 is more specific (91%) and less sensitive (46%). The lower the APRI score (less than 0.5), the greater of the negative predictive value (and ability to rule out of cirrhosis) an d The higher the value (greater than 1.5) the greater the positive predictive value (and ability to rule in cirrhosis); Midrange values is less helpful. The APRI alone is likely not sufficiently sensitive to rule out significant disease. Some evidence suggests, the use of multiple indices in combination (such as APRI plus fibrotest) or an Algori Thmic approach may result in higher diagnostic accuracy than using APRI alone.2

How do I use APRI scoring to diagnose noninvasive cirrhosis of the liver?

Recently, the World Health Organization (WHO) published the Guidelines for prevention, care and treatment of chronic HBV infection [1] recommended the use of APRI scoring for noninvasive cirrhosis diagnosis.

　　What is a APRI rating?

The APRI score is an abbreviation for aspartic acid aminotransferase (AST) and platelet (PLT) ratio index (aspartate aminotransferase-to-platelet Ratio index). Its calculation formula is:

　　

　　APRI score is the origin?

In the past, the diagnosis of liver cirrhosis often had to be determined by ultrasound and laboratory examinations combined with clinical manifestations of cirrhosis. When diagnosed as cirrhosis by these methods, liver lesions have become apparent. Doctors can also be divided into 4 levels of hepatic fibrosis by hepatic puncture pathology to diagnose hepatic fibrosis and cirrhosis. But a liver puncture is a traumatic examination, which can cause pain and cannot be repeated. In addition, the liver tissue taken out by the liver is only about 1/50000 of the liver, and the distribution of hepatic fibrosis is uneven. Doctors have also tried to diagnose liver fibrosis by detecting changes in some of the fibrin in the serum. But these indicators are too inaccurate and are susceptible to lesions in other tissues of the body. How can we reduce the damage to the patient and assess the degree of hepatic fibrosis in the early stages? In recent years, scientists have invented a machine that can detect the hardness of the liver outside the body, according to its English name (FibroScan) transliteration, some netizens call it "flying wave test liver" or "flying wave test Liver", others referred to as "flying wave". However, such examinations are not available in all hospitals. What if the simplest method is used to diagnose and evaluate liver fibrosis and cirrhosis?

[2] An American physician first proposed the use of aspartic acid aminotransferase (AST) and platelet (PLT) ratio indices to evaluate hepatic fibrosis and cirrhosis in 2003. Aspartic acid aminotransferase and platelets are often examined in patients with liver disease, and only these two indicators can be used to assess the fibrosis and cirrhosis of the liver, which is too simple! After more than more than 10 years of research and validation, this approach has been recognized by most physicians and recommended by the World Health Organization [1, 3].

　　How to diagnose cirrhosis with APRI score?

After years of research, if the APRI score >2, it indicates that the patient has undergone cirrhosis.

For example: 1 cases of men with Hepatitis B examination report showed: AST u/l (normal reference range: 0~40 u/l), platelet 95x109/l, then his APRI evaluation is divided into:

　　

This patient's APRI score >2, indicating that he may have developed to cirrhosis stage.

The Hepatitis C Online website of the United States (hepatitis) puts the formula program for APRI scoring directly on the Internet (HTTP://WWW.HEPATITISC.UW.EDU/PAGE/CLINICAL-CALCULATORS/APRI). Patients can directly obtain their own APRI score by inputting the test values of aspartic acid aminotransferase (AST) and its normal value and platelet (PLT) directly online.

It should be noted that hepatitis B and C patients in China often love the use of biphenyl ester, double-ring alcohol, five fat capsules and other enzyme-lowering drugs. These enzymes may cause ALT to drop while AST rises. In this case, the calculation of the APRI score is inaccurate, and the APRI score needs to be calculated without dropping the enzyme.

References

[1] Who. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. 2015-3-12. http://www.who.int/hiv/pub/hepatitis/hepatitis-b-guidelines/en/.

[2] Wai CT, Greenson JK, Fontana RJ, et al. A Simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepat Ology. 2003.38 (2): 518-26.

[3] Lin en, Xin YN, Dong QJ, et al. Performance of the aspartate Aminotransferase-to-platelet ratio index for the Stagi Ng of hepatitis C-related Fibrosis:an updated meta-analysis. Hepatology. 2011.53 (3): 726-36.

Diagnosis of non-invasive cirrhosis with HBV_APRI score