Non-invasive fibrosis assessment in chronic hepatitis C: aspartate-aminotransferase to platelet ratio index (APRI) and transient elastography (FibroScan)

Abstract

Although liver biopsy is the gold standard for the diagnosis of liver disease, non-invasive tests may also play a role in the evaluation of liver fibrosis. Authors studied two fibrosis markers, aspartate-aminotransferase / platelet ratio index (APRI) and liver stiffness (LS) measurement to assess fibrosis in different forms of chronic hepatitis C virus (HCV) infection. out of 119 HCV-infected patients 75 had biopsy-proven chronic hepatitis C, 24 had HCV-cirrhosis, 20 individuals were symptom-free HCV-carriers with persistently normal alanine-aminotransferase and 30 healthy blood donors served as controls. Wai's APRI score was calculated from aspartate-aminotransferase and platelet number. For LS measurement transient elastography (FibroScan) was applied. METAVIR fibrosis score was determined by liver biopsy. In patients with chronic hepatitis C infection both fibrosis markers were significantly elevated comparing to normal controls and the markers were the highest in HCV-associated cirrhosis. Values of symptom-free HCV-carriers corresponded to those obtained from healthy controls. Both APRI and LS results correlated with the METAVIR score. LS identified fibrosis better than APRI. Using a novel sequential algorithm that comprises APRI and LS for assessment of fibrosis, 47.8% of HCV patients did not need biopsy for diagnosing significant (F≥2) fibrosis. both fibrosis markers, particularly in combination, may represent a useful option in the noninvasive assessment of fibrosis in HCV infection.