Non-invasive methods for diagnostics of liver fibrosis in patients with autoimmune hepatitis and autoimmune hepatitis - primary biliary cirrhosis

Abstract

Aim: to evaluate the performance of non-invasive indices for the diagnosis of pronounced fibrosis and cirrhosis in patients with autoimmune hepatitis (AIH) and autoimmune hepatitis - primary biliary cirrhosis variant (AIH-PBC). Methods: Data from 70 patients with AIH and 53 patients with AIH-PBC were analyzed retrospectively. Fibrosis-4 score (FIB-4), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), AST to platelet ratio (APRI) and platelet count to spleen diameter ratio (PLT/SPD) were calculated based on results of blood analyses and abdominal ultrasound. Results of the histological study of the liver with the assessment of the stage of fibrosis (according to the METAVIR score) were obtained for all patients. The diagnostic accuracy of the tests was evaluated based on the area under the receiver operating characteristic curve (AUROC). Results: 51 (72.8%) of the 70 AIH patients (median age [25th - 75th interquartile range] 41 years [27-51]) had markedfibrosis (≥F2) and 28 (40%) presented with cirrhosis. In the PBC-AIHgroup (n=53; median age 50years [43.5- 57]) 42 (79.2%) and 21 (39.6%) patients had marked fibrosis (≥F2) and cirrhosis (F4), respectively. PLT/SPD was superior to other indices studied for the discrimination between mild and severe fibrosis (≥F2) as well as between severe fibrosis and cirrhosis (F4) in AIH (AUROCs: 0.840 [95% confidence interval (CI) 0.744-0.935] and 0.968 [0.934-1.000], respectively) and AIH-PBC (AUROCs: 0.752 [0.584-0.919] and 0.889 [0.800-0.979], respectively). Conclusion: The accuracy of the PLT/SPD index for diagnostics of ≥F2 is 79.1% and 76.9% and for diagnostics of F4 85.1% and 82.7% in AIH and AIH-PBC patients respectively.