Aspartate Aminotransferase-platelet Ratio Research Articles

Noninvasive scores are poorly predictive of histological fibrosis in paediatric fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children. Roughly a quarter of paediatric patients with NAFLD develop nonalcoholic steatohepatitis and fibrosis. Here, we evaluated the diagnostic accuracy of previously published noninvasive fibrosis scores to predict liver fibrosis in a large European cohort of paediatric patients with NAFLD. The 457 patients with biopsy-proven NAFLD from 10 specialized centers were included. We assessed diagnostic accuracy for the prediction of any (F ≥ 1), moderate (F ≥ 2) or advanced (F ≥ 3) fibrosis for the AST/platelet ratio (APRI), Fibrosis 4 score (FIB-4), paediatric NAFLD fibrosis score (PNFS) and paediatric NAFLD fibrosis index (PNFI). Patients covered the full spectrum of fibrosis (F0: n = 103; F1: n = 230; F2: n = 78; F3: n = 44; F4: n = 2). None of the scores were able to accurately distinguish the presence of any fibrosis from no fibrosis. For the detection of moderate fibrosis, area under the receiver operating characteristic curve (AUROC) were: APRI: 0.697, FIB-4: 0.663, PNFI: 0.515, PNFS: 0.665, while for detection of advanced fibrosis AUROCs were: APRI: 0.759, FIB-4: 0.611, PNFI: 0.521, PNFS: 0.712. Fibrosis scores showed no diagnostic benefit over using ALT ≤ 50/ > 50 IU/L as a cut-off. Established fibrosis scores lack diagnostic accuracy to replace liver biopsy for staging of fibrosis, giving similar results as compared to using ALT alone. New diagnostic tools are needed for Noninvasive risk-stratification in paediatric NAFLD.

Machine-learning model comprising five clinical indices andliver stiffness measurement can accurately identify MASLD-related liver fibrosis.

aMAP score, as a hepatocellular carcinoma risk score, is proven to be associated with the degree of chronic hepatitis B-related liver fibrosis. We aimed to evaluate the ability of aMAP score for metabolic dysfunction-associated steatotic liver disease (MASLD; formerly NAFLD)-related fibrosis diagnosis and establish a machine-learning (ML) model to improve the diagnostic performance. A total of 946 biopsy-proved MASLD patients from China and the United States were included in the analysis. The aMAP score, demographic/clinical indices and liver stiffness measurement (LSM) were included in seven ML algorithms to build fibrosis diagnostic models in the training set (N = 703). The performance of ML models was evaluated in the external validation set (N = 125). The AUROCs of aMAP versus fibrosis-4 index (FIB-4) and aspartate aminotransferase-platelet ratio (APRI) in cirrhosis and advanced fibrosis were (0.850 vs. 0.857 [P = 0.734], 0.735 [P = 0.001]) and (0.759 vs. 0.795 [P = 0.027], 0.709 [P = 0.049]). When using dual cut-off values, aMAP had a smaller uncertainty area and higher accuracy (26.9%, 86.6%) than FIB-4 (37.3%, 85.0%) and APRI (59.0%, 77.3%) in cirrhosis diagnosis. The seven ML models performed satisfactorily in most cases. In the validation set, the ML model comprising LSM and 5 indices (including age, sex, platelets, albumin and total bilirubin used in aMAP calculator), built by logistic regression algorithm (called LSM-plus model), exhibited excellent performance. In cirrhosis and advanced fibrosis detection, the LSM-plus model had higher accuracy (96.8%, 91.2%) than LSM alone (86.4%, 67.2%) and Agile score (76.0%, 83.2%), respectively. Additionally, the LSM-plus model also displayed high specificity (cirrhosis: 98.3%; advanced fibrosis: 92.6%) with satisfactory AUROC (0.932, 0.875, respectively) and sensitivity (88.9%, 82.4%, respectively). The aMAP score is capable of diagnosing MASLD-related fibrosis. The LSM-plus model could accurately identify MASLD-related cirrhosis and advanced fibrosis.

Evaluation of systemic inflammatory and fibrosis indices in Saprochaete capitata infections: a retrospective case-control study

Abstract Objectives Evaluation of inflammation and liver fibrosis by using well established indices of serum biomarkers in hepatitis caused by viral agents has been reported in recent studies. But the diagnostic performance and prediction of liver damage in S. capitata infections has not yet been reported. The aim of the current study was to investigate the levels of systemic inflammatory indices based on liver enzymes and platelets, their effectiveness in detecting S. capitata infection and its degree of damage to the liver. Methods We investigated the diagnostic performance of seven serum inflammation and fibrosis markers as fibrosis-4 (FIB-4) score, AST/platelet ratio (APRI), AST/ALT ratio (De Ritis ratio), albumin/ALP ratio (AAR), platelet/albumin ratio (PAR), pan-immune-inflammation value (PIV) and GGT/platelet ratio (GPR) in total 62 S. capitata infected patients using cut-offs through receiver operating characteristics (ROC) analysis. Results Area under the curve of FIB-4 score was statistically significantly higher than ones of De Ritis ratio, AAR, PIV, APR, GPR, APRI index in determining liver damage in patients with S. capitata. The optimal cut off point for FIB-4 score was defined that the levels above 27.57 for FIB-4 score may be used for the diagnosis of S. capitata with 89 % of sensitivity and 91 % of specificity. Conclusions Serum fibrosis and immune-inflammation indices are independent, useful predictors, and FIB4 score is superior to the others in the diagnosis of inflammation and liver damage in S. capitata. These biomarkers may also be useful to specialists to follow up on the medical processes of these patients.

RDW Predicts Fibrosis in Patients with Chronic Hepatitis B Having Persistently Normal ALT Levels.

There are studies on the determination of hepatic fibrosis with noninvasive markers but data about liver biopsy results and noninvasive markers in patients with chronic hepatitis B (CHB) are limited. The aim of this study is to determine the relationship between pathological findings and noninvasive markers, and to determine the marker that predicts fibrosis in patients with consistently normal serum alanine aminotransferase (ALT) levels, diagnosed with CHB and undergoing liver biopsy. A total of 122 patients with CHB, 29 of them with HbeAg (+), aged 30 years and older, HBV DNA > 2000 IU / ml, and serum ALT levels measured four times in the last year, were consistently normal, and 93 of them with HbeAg (-) were included in the study. Demographic characteristics of patients, laboratory parameters, histological activity index (HAI) and fibrosis values obtained in liver biopsy, and noninvasive markers (AP (age-platelet) index, APRI (AST/Platelet ratio) and FIB-4 score, neutrophil/lymphocyte ratio, mean platelet volume (MPV) and erythrocyte distribution width (RDW) were recorded. The relationship between RDW value and fibrosis was statistically significant in the HbeAg (+) group (p<0.001). The relationship between AP index, APRI and FIB-4 score, neutrophil/lymphocyte ratio and MPV with fibrosis was not statistically significant (>0.05 for each). It has been shown that the RDW value can be used to predict fibrosis in CHB patients with normal ALT and HbeAg (+), and the cut-off value for RDW is 12.

AMAP Score and Its Combination With Liver Stiffness Measurement Accurately Assess Liver Fibrosis in Chronic Hepatitis B Patients

The changes in liver stiffness measurement (LSM) are unreliable to estimate regression of fibrosis during antiviral treatment for chronic hepatitis B (CHB) patients. The age-male-albumin-bilirubin-platelets score (aMAP), as an accurate hepatocellular carcinoma risk score, may reflect the liver fibrosis stage. Here, we aimed to evaluate the performance of aMAP for diagnosing liver fibrosis in CHB patients with or without treatment. A total of 2053 patients from 2 real-world cohorts and 2 multicentric randomized controlled trials in China were enrolled, among which 2053 CHB patients were included in the cross-sectional analysis, and 889 CHB patients with paired liver biopsies before and after 72 or 104 weeks of treatment were included in the longitudinal analysis. In the cross-sectional analysis, the areas under the receiver operating characteristic curve of aMAP in diagnosing cirrhosis and advanced fibrosis were 0.788 and 0.757, which were comparable with or significantly higher than those of the fibrosis index based on 4 factors and the aspartate aminotransferase-platelet ratio. The stepwise approach using aMAP and LSM further improved performance in detecting cirrhosis and advanced fibrosis with the smallest uncertainty area (29.7% and 46.2%, respectively) and high accuracy (82.3% and 79.8%, respectively). In the longitudinal analysis, we established a novel model (aMAP-LSM model) by calculating aMAP and LSM results before and after treatment, which had satisfactory performance in diagnosing cirrhosis and advanced fibrosis after treatment (area under the receiver operating characteristic curve, 0.839 and 0.840, respectively), especially for those with a significant decrease in LSM after treatment (vs LSM alone, 0.828 vs 0.748; P < .001 [cirrhosis]; 0.825 vs 0.750; P < .001 [advanced fibrosis]). The aMAP score is a promising noninvasive tool for diagnosing fibrosis in CHB patients. The aMAP-LSM model could accurately estimate fibrosis stage for treated CHB patients.

Thrombospondin-2 as a potential noninvasive biomarker of hepatocyte injury but not liver fibrosis in children with MAFLD: A preliminary study.

Metabolic-associated fatty liver disease (MAFLD) requires close monitoring due to its increased incidence and progression to fibrosis, cirrhosis and even hepatocellular carcinoma. The search for non-invasive markers to diagnose liver fibrosis is ongoing. The aim of our study was to evaluate the serum levels of growth differentiation factor-15 (GDF-15), thrombospondin-2 (TSP2), pentraxin 3 (PTX3) and angiopoietin-like protein 8 (ANGPTL8) in children with MAFLD. Fifty-six overweight/obese children with suspected liver disease were included in this prospective study. MAFLD was diagnosed according to the latest consensus. Vibration-controlled transient elastography (TE) was performed to detect clinically significant liver fibrosis. Serum concentrations of GDF-15, TSP2, PTX3 and ANGPTL8 were measured by enzyme-linked immunosorbent assay (ELISA). Liver steatosis was diagnosed in abdominal ultrasound in 31 (55.36%) overweight/obese patients who were classified as the MAFLD group. Aspartate aminotransferase (AST)/platelet ratio (APRI) and liver stiffness measurement (LSM) values and TSP2 concentrations showed significantly higher values in patients in MAFLD than in the non-MAFLD group. TSP2 was significantly positively correlated with alanine transaminase (ALT), AST, γ-glutamyltransferase (GGT) and APRI in the study group. The receiver operating characteristics (ROC) analysis showed that the area under the curve (AUC) of LSM, APRI and serum TSP2 was significant for predicting MAFLD in obese children. In the multivariable regression model, LSM was the only significant parameter associated with the diagnosis of MAFLD in children. TSP2 may be a potential biomarker of hepatocyte injury in pediatric patients with MAFLD. None of the examined biomarkers were found to be effective non-invasive markers of liver fibrosis in children.

Investigating Up-to-Seven Criteria and APRI (AST Platelet Ratio) as Prognostic Factors in Intermediate-Stage Hepatocellular Carcinoma Patients Who Received Transarterial Chemoembolization.

Transarterial chemoembolization (TACE) is one of the locoregional treatments for intermediate-stage hepatocellular carcinoma (HCC). Multidetector computed tomography (MDCT) is a widely used diagnostic tool for HCC. It can also evaluate tumor size, tumor number, and tumor invasion. This study aimed to determine the median survival time in intermediate-stage HCC patients who underwent TACE and to find out prognostic factors influencing patients' survival time after TACE. A computerized search of medical record database in Maharaj Nakorn ChiangMai Hospital from January 2016 to December 2019 revealed 187 intermediate-stage HCC patients who received TACE as the first-line treatment. The median survival time of patients in this study was 9.9 months (95% CI: 8.3-11.6). The patients with aspartate aminotransferase-to-platelet ratio (APRI) less than 0.5 had a significantly better median survival time as compared with patients with APRI ratio more than 0.5; (13.2 months versus 9.9 months, p-value < 0.05). Univariate and multivariate Cox regression analysis demonstrated that tumor number > 7 and tumor size > 5 centimeters (cm) could be considered as independent parameters predicting poor overall survival time in the sufferers (HR 2.64 95%CI 1.68-4.15 and HR 2.38 95%CI 1.32-4.31, respectively). Based on our findings, patients with intermediate-stage HCC who received TACE had a lower median survival time compared to previous studies. However, we identified APRI less than 0.5, tumor size less than 5 cm, and tumor number less than 7 as prognostic factors improving survival time in intermediate-stage HCC patients.

Assessment of Liver Fibrosis Using Non-invasive Screening Tools in Individuals With Diabetes Mellitus and Metabolic Syndrome.

Introduction: Despite the rising prevalence of liver fibrosis and its potentially life-threatening complications, there are currently no recommendations or guidelines to screen individuals with diabetes mellitus (DM) or high body mass index (BMI) for non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH). This is mainly due to the uncertain performance and feasibility of presently available screening tools. This research was carried out to assess the diagnostic accuracy of non-invasive screening tools in predicting liver fibrosis in individuals with DM and metabolic syndrome.Methods: For this study, 140 patients with DM and metabolic syndrome were identified between March 2020 and October 2021. Liver stiffness measurement by point shear wave elastography was considered the gold standard in our study. Five non-invasive scores such as aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, aspartate aminotransferase to platelet ratio index (APRI) score, fibrosis-4 (FIB-4) index, BARD score, and NAFLD fibrosis score were determined in all of the participants. Using receiver operator characteristic (ROC) curve analysis, sensitivity, specificity, both negative predictive value (NPV) and positive predictive value (PPV) were calculated for each of these scores. The area under the ROC curve (AUROC) was used to calculate the diagnostic accuracy of these scores.Results: Of the 507 individuals screened, 140 were enrolled for the study. Among the 140 participants, 83 were male (59.29%), 30 (21.43%) had liver fibrosis as per liver stiffness measurement by point shear wave elastography, and 110 (78.57%) did not have fibrosis. The mean age and mean BMI were 54.53±12.42 and 27.37±2.73 respectively in the ‘Fibrosis’ group and 56.20 ±11.76 and 27.10±4.22 in the ‘No fibrosis’ group. The major finding of our study was that all these scores had relatively high NPV (>85 %) for predicting liver fibrosis in our cohort. The AST/ALT ratio had the highest NPV (90.28%) followed by APRI Score (88.94%). The AUROC for FIB-4 Score, NAFLD-fibrosis score, APRI score, AST/ALT ratio, and BARDd score were 0.6669, 0.657, 0.655, 0.637 and 0.599, respectively. The FIB-4 index (p=0.005) had the highest AUROC, followed by the NAFLD-fibrosis score (p =0.009). But all the scores had relatively low specificity (<60 %), PPV (<35 %), and accuracy (<63 %).Conclusion: The FIB-4 index and NAFLD-fibrosis score can be used reliably to exclude liver fibrosis in individuals with DM and metabolic syndrome in the Indian population, but may not be useful in accurately diagnosing liver fibrosis. Utilization of these non-invasive and cost-effective screening tools in routine practice may have promising results in predicting liver fibrosis in ‘at risk’ populations.

Correlation between AST Platelet Ratio and Severity of Espohageal Varices in Hepatitis B Induced Cirrhosis

Correlation between AST Platelet Ratio and Severity of Espohageal Varices in Hepatitis B Induced Cirrhosis

Correlation between AST Platelet Ratio and Severity of Espohageal Varices in Hepatitis B Induced Cirrhosis

Liver diseases, especially liver cirrhosis, are common in Pakistan due to the high prevalence of chronic viral hepatitis. Objectives: The basic aim of the study is to analyse the correlation between AST platelet ratio and severity of oesophageal varices in hepatitis B induced cirrhosis. Setting: This cross sectional study was conducted in National Hospital Defence, Lahore during January 2019 to August 2019. Material and methods: This study includes the patient who visited the OPD of the hospital regularly. All patients met the diagnostic criteria for cirrhosis for chronic hepatitis B prevention and treatment was included in this study. We recorded the age of the patients and the levels of AST, ALT, albumin, and PLT in peripheral blood. In addition, patients were divided into slight, moderate, and severe groups according to the morphology of oesophageal varices (EV) and the severity of haemorrhage under gastroscopy. Results: The data were collected from 150 patients of both genders. There were 44 cirrhosis patients without oesophageal varices (nonoesophageal varices group), 43 with mild oesophageal varices (mild group), 31 with moderate oesophageal varices (moderate group), and 32 patients with severe oesophageal varices (severe group). There was no significant difference in age or gender between patients in each group (all p>0.05). Conclusion: It is concluded that HBV infection is the leading aetiological factor underlying cirrhosis. Presentation for screening upper endoscopy is often late and with severe liver disease. Majority of cirrhotics have varices at endoscopy and with most being large varices.

Correlation between AST Platelet Ratio and Severity of Espohageal Varices in Hepatitis B Induced Cirrhosis

Liver diseases, especially liver cirrhosis, are common in Pakistan due to the high prevalence of chronic viral hepatitis. Objectives: The basic aim of the study is to analyse the correlation between AST platelet ratio and severity of oesophageal varices in hepatitis B induced cirrhosis. Setting: This cross sectional study was conducted in National Hospital Defence, Lahore during January 2019 to August 2019. Material and methods: This study includes the patient who visited the OPD of the hospital regularly. All patients met the diagnostic criteria for cirrhosis for chronic hepatitis B prevention and treatment was included in this study. We recorded the age of the patients and the levels of AST, ALT, albumin, and PLT in peripheral blood. In addition, patients were divided into slight, moderate, and severe groups according to the morphology of oesophageal varices (EV) and the severity of haemorrhage under gastroscopy. Results: The data were collected from 150 patients of both genders. There were 44 cirrhosis patients without oesophageal varices (nonoesophageal varices group), 43 with mild oesophageal varices (mild group), 31 with moderate oesophageal varices (moderate group), and 32 patients with severe oesophageal varices (severe group). There was no significant difference in age or gender between patients in each group (all p>0.05). Conclusion: It is concluded that HBV infection is the leading aetiological factor underlying cirrhosis. Presentation for screening upper endoscopy is often late and with severe liver disease. Majority of cirrhotics have varices at endoscopy and with most being large varices.

Νon-Invasive Assessment of Esophageal Varices in Patients with Liver Cirrhosis

Background: Esophageal variceal related bleeding is a lethal outcome of portal hypertension in patients with cirrhosis with mortality. Objective: To assess esophageal varices in patients with liver cirrhosis using non-invasive parameters. Study Design: Cross sectional study. Settings: Gastroenterology Department, Lahore General Hospital, Lahore Pakistan. Duration: 6 months from September 2016 to February 2017. Methodology: Data of all cirrhotic patients admitted in medical ward was collected.&nbsp; Liver cirrhosis was confirmed by abdominal ultrasound. Values of platelet count, serum albumin and serum ALT estimated by automated biochemistry analyzer. Serum ALT / platelet ratio index was measured by formula. Results: It is observed that esophageal varices are most common in middle to old age. 53.9 % of the cirrhosis patients of the age greater than 40 years have esophageal varices.&nbsp; Mean age of patients with esophageal varices (EV) was 40.94 year. Average duration of cirrhosis was 3.09 years and level of serum alanine aminotransferase (ALT) was raised with thrombocytopenia and low serum albumin. Aspartate aminotransferase / platelet ratio (APRI) index was raised as compared to patients without esophageal varices. Conclusion: Esophageal varices are most common in middle to old age and non-invasive assessment including level of serum alanine aminotransferase, aspartate aminotransferase, serum albumin, platelet count and APRI ratio may help to assess esophageal varices in patients with liver cirrhosis.

Diagnostic Accuracy of Noninvasive Fibrosis Models to Detect Change in Fibrosis Stage

Noninvasive methods are needed to determine disease stage in patients with nonalcoholic fatty liver disease (NAFLD). We evaluated the diagnostic performance of several widely available fibrosis models for the assessment of hepatic fibrosis in patients with NAFLD. We performed a retrospective analysis of data from individuals enrolled in the NIDDK NASH Clinical Research Network, from 2004 through 2018. Using biopsy as the reference standard, we determined the diagnostic performance of the aspartate aminotransferase (AST):platelet ratio (APRI), FIB-4, ratio of AST:alanine aminotransferase (ALT) and the NAFLD fibrosis score (NFS) in a cross-sectional study of 1904 subjects. The ability of these models to detect changes in fibrosis stage was assessed in a longitudinal data set of 292 subjects with 2 biopsies and accompanying laboratory data. Outcomes were detection of fibrosis of any stage (stages 0-4), detection of moderate fibrosis (stages 0-1 vs 2-4), and detection of advanced fibrosis (stages 0-2 vs 3-4). Diagnostic performance was evaluated using the C-statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) analyses. In the cross-sectional study, FIB-4 and NFS outperformed other non-invasive models for detecting advanced fibrosis; the C-statistics were 0.80 for FIB-4 and 0.78 for NFS. In the longitudinal study, 216 patients had non-advanced fibrosis at baseline and 35 patients progressed to advanced fibrosis after median follow up of 2.6 years. After we adjusted for fibrosis stage and model score at initial biopsy, change in APRI, FIB-4, and NFS were significantly associated with change in fibrosis. A unit change in APRI, FIB-4, or NFS was associated with changes in fibrosis stage of 0.33 (95% CI, 0.20-0.45; P < .001), 0.26 (95% CI, 0.15-0.37; P < .001), and 0.19 (95% CI, 0.07-0.31; P= .002), respectively. The cross-validated C-statistic for detecting progression to advanced fibrosis for APRI was 0.82 (95% CI, 0.74-0.89), for FIB-4 was 0.81 (95% CI, 0.73-0.81), and for NFS was 0.80 (95% CI, 0.71-0.88). In a combined analysis of data from 2 large studies, we found that FIB-4, APRI, and NFS can detect advanced fibrosis and fibrosis progression in patients with NAFLD.

Study on the relationship between insulin growth factor 1 and liver fibrosis in patients with chronic hepatitis C with type 2 diabetes mellitus.

To investigate the correlation between serum protein level of insulin growth factor 1 (IGF-1) and the degree of liver fibrosis in patients with chronic hepatitis C (CHC) combined with type 2 diabetes mellitus (T2DM). The cases are divided into four groups. Then serum levels of IFG-1, alanine aminotransferase (ALT), aspartate aminotransferase (AST), hepatitis C virus (HCV) RNA, and HCV genotypes were detected simultaneously in patients with hepatitis C, liver stiffness measurement (LSM) was measured by transient elastography, and aspartate aminotransferase platelet ratio (APRI) score was determined. There was no significant difference between CHC with T2DM group and CHC group in diabetes family history (P > 0.05), but the difference between the two groups were significantly lower than that of T2DM group ( P < 0.05). The levels of fasting insulin and homeostatic model assessment of insulin resistance (HOMA-IR) in CHC group with T2DM group were significantly higher than those in the other two groups ( P < 0.05), while the IGF-1 RNA and the serum protein level in the two groups were significantly lower than those in the CHC group, and were lower than those in the control group ( P < 0.05). The level of serum IGF-1 was negatively correlated with HOMA-IR, LSM, and APRI score in CHC with T2DM group ( r = -0.71, -0.75, and -0.69; P < 0.01). The degree of hepatic fibrosis in patients with CHC combined with T2DM was higher than that in non-T2DM patients with CHC, which was mainly related to insulin resistance (IR) induced by 1b genotype HCV infection. IR can lead to impaired synthesis of IGF-1, and the degree of damage has a corresponding relationship with hepatic fibrosis.

Comparative efficacy and safety of sorafenib in elderly versus non-elderly patients with advanced hepatocellular carcinoma (HCC) with varying liver dysfunction.

430 Background: Sorafenib is the only FDA-approved systemic therapy for advanced HCC. The incidence of HCC increases with age, peaking above 70 years; however, we have limited efficacy and safety data in the elderly. Given the prevalence of HCC in South Texas, we assessed the efficacy and safety of sorafenib in the elderly. Methods: Retrospective analysis of HCC patients (pts) receiving sorafenib from 2008-2013. PFS and OS were estimated from Kaplan-Meier curves and groups were statistically compared with the log rank test. The magnitude of association between dichotomous factors and survival was estimated with the hazard ratio (HR). Adverse events (AEs) were graded according to the Common Terminology Criteria for Adverse Events version 4.0. Differences between age groups (65+, &lt; 65) for dose reduction (yes, no), and AEs were analyzed using Fisher’s Exact Test. Results: A total of 118 pts were included. Median age 57 (range 41-93; 65+ 26%). males 81%. Hispanic 73%, Non-Hispanic White 24%. ECOG PS 0–1 93 %. Causes of cirrhosis: Hepatitis C 66%, Hepatitis B 4%, EtOH 58%. Portal vein thrombosis 36%, Extrahepatic disease 38%. Child-Pugh score: A 56%, B 44%. BCLC class: B 13%, C 87%. Among 113 pts 34% were started at 400 mg daily versus 66% started at 800 mg daily. mOS was 11.2 months (mo) (95% CI: 7.8-14.0), mPFS 5.2 mo (95% Cl: 3.9-7.1). In subgroup analysis, mOS for &lt; 65 was 10.2 mo vs 13.5 mo for 65+ (HR 0.67, 95% CI: 0.39-1.16, p = 0.15). mPFS for &lt; 65 was 4.6 mo vs 6.2 mo for 65+ (HR 0.92, 95% CI: 0.58-1.45, p = 0.71). Among 109 pts, dose reductions in &lt; 65 vs 65+ were 64.6 vs 70% (P = 0.66); survival differences were not statistically significant. Among 75 pts there was a trend to improved survival in 65+ patients with AST/Platelet Ratio (APRI) &lt; / = 1.68, but not statistically significant. Sorafenib was tolerated in the elderly. In regards to nausea, fatigue, diarrhea and hand foot syndrome, difference in toxicity was not statistically significant in &lt; 65 versus 65+. Conclusions: In advanced HCC, elderly pts should be offered sorafenib, as it has efficacy and is tolerated in the elderly. Further prospective studies in the elderly are warranted, with evaluation of APRI as a prognostic marker.

Stepwise application of fibrosis index based on four factors, red cell distribution width-platelet ratio, and aspartate aminotransferase-platelet ratio for compensated hepatitis B fibrosis detection.

Fibrosis index based on four factors (FIB-4) and aspartate aminotransferase-platelet ratio (APRI) were validated with unsatisfactory efficiency. Routine hematology index red cell distribution width-platelet ratio (RPR) had been tried in liver fibrosis detection. This study tries to evaluate the stepwise application of FIB-4, RPR, and APRI in detecting chronic hepatitis B (CHB) fibrosis. A total of 246 compensated CHB patients who underwent liver biopsies, transient elastography, and routine blood tests including complete blood count were included. Dual cut-offs were determined to exclude or include cirrhosis diagnosis. Performance of stepwise combining routine biomarkers including RPR, FIB-4, and APRI were statistically analyzed. The Metavir F0, F1, F2, F3, and F4 were identified in 2.4%, 22.0%, 32.1%, 24.0%, and 19.5% of the eligible patients, respectively. The area under receiver operating characteristics curves for detecting significant fibrosis and cirrhosis were 0.853 and 0.883 for transient elastography; 0.719 and 0.807 for FIB-4; 0.638 and 0.791 for RPR; 0.720 and 697 for APRI; and 0.618 and 0.760 for mean platelet volume-platelet ratio, respectively. The proportion of patient determined as cirrhosis or non-cirrhosis was 65.9% by transient elastography, 36.9% by FIB-4, 30.5% by RPR, and 19.5% by APRI, respectively. These numbers for determining significant fibrosis were 49.6%, 24.2%, 21.5%, and 23.6% in the same order. Detected by stepwise application of FIB-4, RPR, and APRI, 41.5% and 52.8% of patients could be determined the state of significant fibrosis and cirrhosis, respectively. In source-limited settings without transient elastography, stepwise applying FIB-4, RPR, and APRI could free nearly half of CHB patients from liver biopsies in detecting significant fibrosis and cirrhosis.

Comparison of Fibroscan to Simple Noninvasive Screening Tools in Predicting Fibrosis in NAFLD Patients of Western India With High Risk of Liver Fibrosis

The study is aimed to determine the efficacy of Fibroscan as compared to noninvasive markers, NAFLD Fibrosis Score (NFS), APRI (AST/Platelet ratio) and AAR (AST/ALT ratio) as a screening tool in NAFLD patients with high risk of liver fibrosis. This is a single center study carried out in patients attending OPD for dyspepsia and diagnosed as fatty liver on ultrasound. Liver biopsy was advised in diabetics, metabolic syndrome, BMI>30kg/m2, raised transaminases and hypothyroidism. Fibroscan, APRI, AAR and NFS were calculated. AUROC, NPV, PPV was calculated for each diagnostic test. Of 1,500 patients screened, 110 with above described risk factors underwent liver biopsy (72 had F Stage 0/1/2 fibrosis, 38 showed stage 3/4 Fibrosis). Diabetes predicted severe fibrosis (stage 3/4) as compared to mild disease. The sensitivity, specificity, PPV, NPV and AUROC for Fibroscan at value 12 kPa was 0.9, 0.8, 0.70, 0.93 and 0.91, respectively, for predicting stage 3/4 fibrosis. With increase in severity of liver fibrosis there was step wise increase in Fibroscan values (P = .000038, Kruskal–Wallis test). The sensitivity, specificity, PPV and NPV for AAR and NFS at cutoff of 1.5 and 0.676 is 0.8, 1.0, 1.0 and 0.92 and 0.8, 1.0, 1.0 and 0.92 respectively. Fibroscan, NFS and AAR are simple noninvasive markers of fibrosis that can be utilized as a screening tool in patients with high risk for fibrosis to determine the need for biopsy. The cutoff of Fibroscan for stage 3/4 fibrosis was 12 kPa.

Mean Platelet Volume, Red Cell Distribution Width to Platelet Count Index, Globulin Platelet Index, and Twelve Other Simple Non-invasive Fibrosis Scores: How Much Do Routine Blood Tests Tell About Liver Fibrosis?: ACG Governors Award for Excellence in Clinical Research

Introduction: There are many simple non-invasive scores to predict liver fibrosis that can be calculated from routine blood parameters. We aim to compare these simple non-invasive scores for evaluation of liver fibrosis with liver biopsy in patients with chronic hepatitis C (HCV). Methods: In 1,602 HCV patients who underwent liver biopsy, we compared the liver biopsy (Scheuer classification) fibrosis scores with APRI (AST/Platelet ratio), Fibrosis-4 (FIB-4), Lok score, GUCI score, Fibro-alpha score, Forns’ score, King score, AAR (AST/ALT ratio), Fibrosis index (FI), Pohl score, Fibro-Q score, FCI (Fibrosis cirrhosis index), and 3 new scores: mean platelet volume (MPV), RPR (red cell distribution width/platelet count ratio), and globulin/platelet count index (GPI). Results: Mean age of patients was 41.8±9.6 years (1,365 males); genotype 4 (65.6%) was the most common, followed by genotype 1 (10.9%). Liver biopsy showed stage 0 fibrosis (F0) in 1.9%, stage 1(F1) in 32.9%, stage 2(F2) in 39.5%, stage 3(F3) in 19%, and stage 4(F4) in 6.6% of patients. Of the baseline parameters, AST (adjusted odds ratio [OR] 1.015; confidence interval [CI] 1.008-1.022; p=0.001), albumin (adjusted OR 0.842; CI 0.742-0.915; p=0.001) and platelet count (adjusted OR 0.981; CI 0.974-0.989; p=0.001) were independent predictors of cirrhosis. We derived a study score (8.5 -0.2 [albumin, g/dl] + 0.01[AST, IU/l] - 0.02 [platelet count, 109/l]) at a cut-off of >4.7; it had high predictive accuracy (AUROC=0.868; CI 0.833-0.904) for cirrhosis. All the scores except AAR and Pohl score showed high predictive accuracy for cirrhosis (Table 1). Of the new scores, MPV and RPR had relatively low, and GPI had high, predictive accuracy for cirrhosis. GUCI score (cut-off >1.1) had the highest predictive accuracy for cirrhosis, followed by APRI (cut-off >1.5). King’s score had highest predictive accuracy for significant (F2-F4) and advanced fibrosis (F3-4), AUROC of 0.771 and 0.860, respectively.Table 1: Performance of Non-invasive Scores Compared to Cirrhosis(F4-Fibrosis) in Liver BiopsyConclusion: Excluding AAR, Pohl score, MPV, and RPR, all the non-invasive scores including the study score we derived, and GPI showed high predictive accuracy for cirrhosis. GUCI score and APRI for cirrhosis and King’s score for significant and advanced fibrosis seem to have the highest predictive accuracy.

Su1483 AST Platelet Ratio (APRI Scores) Correlates With Hepatoportal Pressure Measurements

Background and aims: The presence of fibrosis on liver biopsy is a prognostic tool for management of liver disease. AST/PLT ratio index (APRI) has been shown to be a useful tool to non-invasively predict fibrosis. Hepatoportal pressure gradient (HPPG) measurements have been used as an instrument to predict complications from cirrhosis. To the best of our knowledge, there has been no prior study comparing HPPG measurements to APRI scores. We aimed to elucidate the relationship between APRI scores and HPPG measurements. Methods: We retrospectively reviewed liver biopsy results of patients (n = 125) between 2009 and 2011. Patients who had no coinciding liver function tests within one week of liver biopsy (n=25) and those without coinciding measurements of hepatic venous pressures (n =58) were also excluded. A total of 67 patients were analyzed. The AST platelet ratio (APRI) were obtained and compared to HPPG =10 (n=13) mmHg. Results: Median age was 60 (range 30-80) and 38 (59%) were male. Hepatitis C was present in 35 (52%) of patients, 13 of whom had undergone liver transplantation with recurrence of hepatitis C. Table 1 shows the etiology of liver diagnoses. Mean APRI score was 0.52 + 0.51 in patients who had HPPG =10, p =0.04. Pearson's correlation between APRI score and HPPG measurement was 0.27, p = 0.03. Conclusions: AST/platelet ratio index (APRI) has been shown to be an important noninvasive diagnostic marker for fibrosis. There is a significant relationship between APRI scores and the severity of hepatoportal pressures. Etiology of liver disease diagnoses in our patients

Su1484 Upper Gastrointestinal Bleeding in Patients With Cirrhosis and Hepatocellular Carcinoma is Associated With Rebleeding and Increased Mortality

Background and aims: The presence of fibrosis on liver biopsy is a prognostic tool for management of liver disease. AST/PLT ratio index (APRI) has been shown to be a useful tool to non-invasively predict fibrosis. Hepatoportal pressure gradient (HPPG) measurements have been used as an instrument to predict complications from cirrhosis. To the best of our knowledge, there has been no prior study comparing HPPG measurements to APRI scores. We aimed to elucidate the relationship between APRI scores and HPPG measurements. Methods: We retrospectively reviewed liver biopsy results of patients (n = 125) between 2009 and 2011. Patients who had no coinciding liver function tests within one week of liver biopsy (n=25) and those without coinciding measurements of hepatic venous pressures (n =58) were also excluded. A total of 67 patients were analyzed. The AST platelet ratio (APRI) were obtained and compared to HPPG =10 (n=13) mmHg. Results: Median age was 60 (range 30-80) and 38 (59%) were male. Hepatitis C was present in 35 (52%) of patients, 13 of whom had undergone liver transplantation with recurrence of hepatitis C. Table 1 shows the etiology of liver diagnoses. Mean APRI score was 0.52 + 0.51 in patients who had HPPG =10, p =0.04. Pearson's correlation between APRI score and HPPG measurement was 0.27, p = 0.03. Conclusions: AST/platelet ratio index (APRI) has been shown to be an important noninvasive diagnostic marker for fibrosis. There is a significant relationship between APRI scores and the severity of hepatoportal pressures. Etiology of liver disease diagnoses in our patients