Aspartate Aminotransferase-platelet Ratio Index Research Articles

Analysis on the value of soluble intercellular adhesion molecule-1 (sICAM-1), alpha fetoprotein (AFP), and aspartate aminotransferase/platelet ratio index (APRI) in predicting the prognostic survival of patients with primary liver cancer after radiofrequency ablation

To analyze the value of soluble intercellular adhesion molecule-1 (sICAM-1), alpha fetoprotein (AFP), and aspartate aminotransferase (AST)/platelet (PLT) ratio index (APRI) in predicting the prognostic survival of patients with primary liver cancer after radiofrequency ablation (RFA). The data of 115 patients with primary liver cancer admitted to our hospital from June 2016 to June 2018 were retrospectively analyzed as the research group, and 120 healthy people who were examined during the same period were selected as the control group. Multivariate logistic regression analysis was used to analyze the risk factors that affect the prognostic survival of patients with primary liver cancer treated with RFA. Receiver operating characteristic (ROC) curve was used to analyze the value of serum sICAM-1, AFP, and APRI levels in predicting the prognostic survival of patients with primary liver cancer after RFA. The levels of sICAM-1, AFP, and APRI in the control group were significantly lower than those in the study group, and the difference between the 2 groups was statistically significant (P<0.05). After 115 patients were followed up for 2 years, the 2-year survival rate was 55.65% (64/115). Multivariate logistic regression showed that the clinical stage: III + IV, extrahepatic metastasis, abnormal increasing in sICAM-1, AFP, and APRI levels, were independent risk factors affecting the prognosis survival of hepatocellular carcinoma (HCC) patients after RFA treatment (P<0.05). The ROC curve showed that the areas under the curve of sICAM-1, AFP, APRI, and their combination in predicting the prognosis survival of HCC patients after RFA treatment were 0.693, 0.828, 0.901, and 0.947, respectively, with the area under the curve of the combination being the largest. ICMS-1, AFP, and APRI are closely related to the RFA treatment and prognosis of HCC patients. In clinic, individualized treatment plans can be formulated based on these levels, which can contribute to prolonging the survival of patients.

Serum fibroscores APRI, FIB-4 and fibroscan in assessment of liver fibrosis in alcoholic associated liver disease

Background: Alcohol-associated liver disease includes a variety of clinical disorders which include steatosis, Alcoholic steato hepatitis, alcoholic hepatitis of varying degrees of severity, alcoholic cirrhosis, and alcohol associated cirrhosis complicated by hepatocellular carcinoma (HCC). In patients with alcoholic liver disease the presence of hepatic (liver) fibrosis and progression into cirrhosis is a prognostic variable and having impact on survival. To assess hepatic (liver) fibrosis using serum fibro scores fibrosis-4 (FIB-4) scores, AST platelet ratio index (APRI scores) and to compare these results with fibro scan to rule out severe fibrosis in patients with alcohol related disease.Methods: A cross sectional clinical study conducted on 50 patients with alcohol associated chronic liver disease between December 2019 to December 2020 who were in follow up in outpatient department (OPD) and admitted in the Department of Medical Gastroenterology. APRI and FIB-4 scores were calculated and compared with fibro scan values.Results: The results of 50 patients were analysed, including, males with a mean age. Among the study population, 6 (12%) participants had no significant FIB-4, 16 (32%) participants had intermediate FIB-4 and 28 (56%) participants had likely cirrhosis. 33 (66%) participants had no significant APRI, 6 (12%) participants had significant APRI and 11 (22%) participants had cirrhosis liver. Among the people with fibro scan KPA F0-F1 (&lt;7), all of them 100% were no significant FIB-4. Among the people with fibro scan KPA F2 (7 To 9.50), 2 (50%) were no significant FIB-4 and intermediate FIB-4 for each respectively.Conclusions: FIB-4 score correlated better than APRI score in assessing patients with and without severe fibrosis and cirrhosis in the setting of alcohol associated liver disease patients.

Liver fibrosis improvement assessed by magnetic resonance elastography and Mac-2-binding protein glycosylation isomerin patients with hepatitis C virus infection receiving direct-acting antivirals.

Fibrosis regression has been observed in patients with chronic hepatitis C virus (HCV) infection treated with direct-acting antivirals. This study was aimed at evaluating dynamic changes of serum Mac-2-binding protein glycosylation isomer (M2BPGi) in patients with HCV genotype 1 receiving elbasvir/grazoprevir. M2BPGi were serially measured at baseline, during and after therapy. Its diagnostic performance at baseline and sustained virological response at 24weeks after treatment (SVR24) were compared with transient elastography (TE) and the aspartate aminotransferase/platelet ratio index (APRI) using magnetic resonance elastography (MRE) as a reference. Overall, 60 HCV mono-infected and 36 HCV/HIV co-infected patients were included with SVR24 rates of 93.3% and 97.2%, respectively. At baseline, TE, M2BPGi and APRI were correlated with MRE (r=0.788, r=0.703 and r=0.564, respectively, p<0.001). The area under the receiver operator characteristics curves for TE, M2BPGi and APRI in differentiating significant fibrosis were 0.88 (95% confidence interval; 0.81-0.95, p<0.001), 0.86 (0.79-0.94, p<0.001) and 0.74 (0.64-0.83, p<0.001), respectively. The corresponding figures for cirrhosis were 0.95 (0.90-1.00, p<0.001), 0.96 (0.92-1.00, p<0.001) and 0.88 (0.79-0.97, p<0.001), respectively. Compared with baseline, all fibrosis markers significantly declined after achieving SVR24. The correlations of TE, M2BPGi and APRI with MRE at time of SVR24 were r=0.587 (p<0.001), r=0.457 (p<0.001) and r=0.293 (p=0.004), respectively. In multivariate analysis, high baseline alanine aminotransferase level, HCV mono-infection and advanced fibrosis were factors associated with M2BPGi reduction. HCV eradication is associated with liver fibrosis improvement. M2BPGi has a better performance than APRI in monitoring liver fibrosis in patients treated with direct-acting antivirals. This marker is applicable in resource-limited settings where imaging-based modalities are not widely accessible.

Assesmentof Fibro Q test, AAR &amp; APRI indices as markers of fibrosis in chronic liver disease

Chronic liver disease can vary from mild hepatic inflammation without fibrosis to advanced hepatic fibrosis and cirrhosis. The use of ultrasound for the confirmation of complications during biopsy procedures increases the cost of treatment and may also increase the duration of hospitalization. Fibro Q test (FQT), Aspartate amino transferase – Alanine amino transferase ratio (AAR) &amp; Aspartate amino transferase- platelet ratio index (APRI) are the three non-invasive and simple indices proposed for assessing fibrosis in CLD. To know the efficacy of the indices- Fibro Q test, AAR, APRI as markers of Fibrosis in CLD. To know which among these indices would be the high sensitive marker of liver fibrosis.This study includes 60 subjects, out of which 30 were clinically diagnosed as CLD and were confirmed by abdominal ultrasound and 30 were age matched healthy controls. Fibro Q, AAR &amp; APRI were significantly increased in cases compared to controls. The increase in Fibro Q test in cases was highly significant (p-0.0001) when compared to controls.Fibro Q test, AAR &amp; APRIindicesare efficient markers to evaluate liver fibrosis in CLD patients. Fibro Q, a novel non-invasive test, is highly sensitive marker than AAR &amp; APRI.

Improvement in Liver Stiffness in Pediatric Patients with Hepatitis C Virus after Treatment with Direct Acting Antivirals

To assess the degree of liver stiffness using transient elastography in Egyptian children infected with hepatitis C virus (HCV) at baseline and 1year after achievement of sustained virologic response (SVR) with direct acting antivirals. This prospective study included children infected with HCV who received treatment with sofosbuvir/ledipasvir and achieved SVR. At baseline and 1year after achievement of SVR, the extent of hepatic fibrosis was assessed by transient elastography using FibroScan to measure liver stiffness, in addition to noninvasive markers including aspartate aminotransferase/platelet ratio index (APRI) and fibrosis-4 (FIB-4) index. The study included 23 cases that had variable degrees of fibrosis at baseline; their ages ranged between 10 and 18years. At baseline, 13 patients had F1; 3 patients had F1-F2; 1 patient had F2; 3 patients had F3; 2 had F3-F4; and 2 patients with F4. One year after achievement of SVR, there was a statistically significant improvement in liver stiffness, APRI, and FIB-4 index (P=.03, <.001, .02, respectively). In 13 patients (56.5%), the liver stiffness improved; in 7 patients, it was stationary; and the remaining 3 patients showed mild increase in liver stiffness that was, however, associated with improvement in APRI and FIB-4 index. Comorbid conditions and previous treatment with interferon were not associated with increased liver stiffness 1year after SVR. Egyptian children infected with HCV genotype 4 achieved significant regression in liver stiffness after treatment with direct acting antivirals.

Hepatitis C Rapid Point-of-Care Testing and Laboratory-based Non-invasive Assessment of Liver Fibrosis among Drug Abusers: An Experience from Iran.

People who use drugs, particularly injection drug users (IDUs) are known as the major source of hepatitis C virus (HCV) infection. This study was performed to determine the prevalence of HCV infection using rapid point-of-care testing and to assess liver fibrosis by non-invasive lab tests among addict populations of Mashhad, Iran. In this cross-sectional study, drug users who referred to drug treatment and harm reduction centers of Mashhad were enrolled during March and December 2019. A rapid test kit was used to assess the presence of anti-HCV antibodies and a real-time PCR was performed to confirm the infection. The AST-platelet ratio index (APRI) and fibrosis-4 (FIB-4) score were used to investigate liver fibrosis in patients with positive HCV RNA. A P value <0.05 was considered as significant. A total of 390 drug users aged 15-74 years were assessed. Sixty-four individuals showed positive results for anti-HCV (16.4%), of whom 58 blood samples were available for PCR test. The viremic rate among the latter group was calculated at 84.5% (49/58); the total viremia prevalence was 12.8% (49/384). Multivariate analysis revealed that being single (P = 0.040) or divorced/ widow (P = 0.011) and history of drug injection (P<0.001) and tattoos (P = 0.021) were significantly associated with current HCV infection. Using APRI and FIB-4 indices, significant liver fibrosis was identified in 14.3% and 18.4% of cases, respectively. HCV infection screening using rapid tests and examining liver fibrosis by non-invasive lab tests appear to be practicable and useful among poor populations in settings such as drug treatment centers.

Accuracy of noninvasive tests in the prediction of portal hypertensive gastropathy in Egyptian patients with cirrhosis.

Background and AimLiver cirrhosis (LC) is commonly associated with portal hypertensive gastropathy (PHG), and it causes gastrointestinal (GI) bleeding. Esophagogastroduodenoscopy (EGD) is the gold standard in diagnosing PHG. Besides its invasiveness, the disadvantages of EGD include psychological and financial problems. We aimed to evaluate the diagnostic accuracy of different noninvasive screening tools in predicting PHG.MethodsThis cross‐sectional study was conducted on 100 patients with LC who were divided into two groups based on EGD: group (A), 50 patients with LC with PHG, and group (B), 50 patients with LC without PHG. All patients were subjected to history taking, full clinical examination, laboratory investigations, abdominal–pelvic ultrasonography, and EGD.ResultsTo predict PHG, the respective sensitivity and specificity of portal vein diameter (>10.5 mm) were 86 and 67%, of gallbladder wall thickness (GBWT) (>3.5 mm) were 64 and 68%, of platelets/GBWT (<40) were 68 and 78%, of aspartate aminotransferase (AST)/platelet ratio index (APRI) score (>1.1) were 60 and 66%, of platelet/spleen diameter (<1290) were 88 and 72%, of right liver lobe diameter/albumin ratio (>4) were 74 and 80%, and of AST/alanine aminotransferase (ALT) ratio (>1.1) were 50 and 58% (P = 0.353).ConclusionPortal vein diameter, platelet/spleen diameter, and right liver lobe diameter/albumin ratio were independently associated with PHG and were good predictors of the PHG, whereas AST/ALT ratio and King score are poor predictors.

A Stepwise Algorithmic Approach and External Validation Study for Noninvasive Prediction of Advanced Fibrosis in Nonalcoholic Fatty Liver Disease.

Advanced F3-4 fibrosis predicts liver-related mortality in nonalcoholic fatty liver disease (NAFLD). Noninvasive tests, designed to rule in/out advanced fibrosis, are limited by indeterminates, necessitating biopsy. We aimed to determine whether stepwise combinations of noninvasive serum-based tests and elastography (VCTE) could predict F3-4, reduce indeterminates, and decrease liver biopsies. Five hundred forty-one biopsy-proven NAFLD cases were identified between 2010 and 2018 from two Canadian centers. Characteristics of training (n = 407)/validation (n = 134) cohorts included: males 54%/59%; mean age 48.5/52.5years; mean body mass index 32.3/33.6kg/m2; diabetes mellitus 30%/34%; and F3-4 48%/43%. For training/validation cohorts, area under the receiver operating curve (AUROC) for FIB-4, AST-platelet ratio index (APRI), NAFLD fibrosis score (NFS), BARD score, and AST/ALT ratio ranged from 0.70 to 0.83/0.68 to 0.81, with indeterminates 25-39%/34-45%, for F3-4. In the training cohort, parallel FIB-4 + NFS had good accuracy (AUROC = 0.81) but was limited by 38% indeterminates and 16% misclassified. Sequential FIB-4 → NFS reduced indeterminates to 10%, and FIB-4 → VCTE to 0%, misclassified 20-22%, while maintaining high specificity (0.88-0.92) and accuracy (AUROC 0.75-0.78) for combined cohorts. Liver biopsy could have been avoided in 27-29% of patients using sequential algorithms. Sequential FIB-4➔NFS/VCTE predicts F3-4 with high specificity and good accuracy, while reducing indeterminates and need for biopsy. Parallel algorithms are limited by high indeterminates. Sequential FIB-4➔NFS had similar accuracy to VCTE-containing algorithms. Validation in low-prevalence cohorts may allow for potential use in community or resource-limited areas for risk stratification.

Preoperative APRI+ALBI Score Allows Risk Stratification Prior to Liver Resection

Background: Preoperative risk assessment for postoperative liver dysfunction (LD) still poses a major challenge in patients undergoing liver resection. Aspartate Aminotransferase/Platelet Ratio Index (APRI) and Albumin-Bilirubin Grade (ALBI) are validated markers in patients suffering from hepatic pathologies. Within this analysis, we aimed to validate our recent exploratory findings in a larger cohort focusing on clinically relevant outcome parameters and subsequently develop a web based application system to facilitate easy clinical translation. Methods: Assessing the National Surgical Quality Improvement Program (NSQIP) database, we identified 13401 patients undergoing liver resection from 2014 to 2017 for preoperative blood values and detailed 30-day postoperative outcomes. Preoperative APRI+ALBI score was calculated from these routine laboratory tests. Results: The scores (APRI and ALBI) significantly predicted postoperative grade C liver dysfunction, 30-days mortality and LD associated 30-days mortality upon receiver operating characteristic analyses (all P < 0.001). The combination of both scores was superior to MELD as well as each individual score. Upon multivariable analysis APRI+ALBI remained an independent predictor of postoperative LD associated 30-day mortality. We further developed a web based application to calculate the APRI+ALBI score to define the specific risk of postoperative grade C LD and more importantly 30-day mortality for the APRI+ALBI score. Conclusion: APRI+ALBI is vital to predict clinically meaningful postoperative outcome after liver resection. Further we developed a web based application to allow clinical translation of these findings and facilitate quick and easy risk assessment prior to liver resection using routine laboratory parameters.

Changes in Liver Stiffness and Noninvasive Fibrosis Scores in Egyptian Adolescents Successfully Treated with Ledipasvir-Sofosbuvir for Chronic Hepatitis C Virus Infection

To assess changes in noninvasive liver fibrosis measurements after chronic hepatitis C eradication by direct-acting antivirals in Egyptian adolescents. Liver stiffness measurement (LSM), by vibration-controlled transient elastography and noninvasive fibrosis scores (Firbosis-4, aspartate aminotransferase-platelet ratio index), was obtained before and 12months after eradication with ledipasvir-sofosbuvir. The primary outcome was a more than 30% decrease in LSM with resulting fibrosis stage regression for initial fibrosis of F2 or higher and nonprogression of F0-F1, using the Ishak score (F0-F6). The secondary outcome was change in noninvasive fibrosis scores after treatment. Analyzing 85 patients, the median baseline LSM was 5.8 (IQR, 4.2-6.5) and at follow-up 5.1kPa (IQR, 4-6kPa)(P=.045); 62 (73%) met the primary outcome, 16 patients (19%) experienced regression, and 46 (54%) nonprogression of LSM. Of 18 with initial fibrosis of F2 0r higher, 13 regressed to F0-F1 and 2 from F6 to F5, 1 unchanged at F3, and 1 increased to F3 and 1 to F4. Among 67 patients with a baseline fibrosis of F0-F1, 62 were unchanged and 5 increased-4 to F2 and 1 to F3. Although 23 (27%) had a more than 30% LSM increase, only 7 (8%), with associated comorbidities (4 β-thalassemia, 3 hepatic steatosis), had increased fibrosis stage. The median baseline FIB-4 and aspartate aminotransferase-platelet ratio index scores were 0.34 (IQR, 0.22-0.47) and 0.35 (0.24-0.57), and at follow-up 0.3 (IQR, 0.22-0.34) and 0.2 (0.18-2.8) (P<.001, <.001), respectively. Chronic hepatitis C eradication by direct-acting antiviral agents in Egyptian adolescents was associated with nonprogression or regression of liver fibrosis, by noninvasive fibrosis measurements, at 12months after treatment in the majority of cases.

Ambulatory end-stage liver disease in Ghana; patient profile and utility of alpha fetoprotein and aspartate aminotransferase: platelet ratio index

BackgroundEnd-stage liver disease (ESLD) is a major burden on public health, particularly in sub-Saharan Africa, where hepatitis B virus (HBV) is an important risk factor. We aimed to describe clinical characteristics of ESLD from cirrhosis or hepatocellular carcinoma (HCC) and the performance of aspartate aminotransferase (AST)—platelet ratio index (APRI) and alpha fetoprotein (AFP) in Ghana.MethodsWe performed an observational cross-sectional study in outpatient hepatology clinics at three teaching hospitals in Ghana, West Africa. One hundred and forty-one HCC, 216 cirrhosis and 218 chronic HBV patients were recruited by convenience sampling. Sociodemographic, history and examination, laboratory, and disease staging information were shown using descriptive statistics. Performance of the APRI score in diagnosis of cirrhosis and AFP in the diagnosis of HCC was determined using AUROC analysis.ResultsMedian age at presentation was 44 years for HCC and 46 years for cirrhosis. HBV was found in 69.5% of HCC and 47.2% of cirrhosis cases, and HCV in 6.4% and 3.7% respectively. APRI cut-off of 2 had sensitivity of 45.4% and specificity of 95% in diagnosis of cirrhosis, and cut-off of 1 had sensitivity of 75.9% and specificity of 89%. AUC of AFP was 0.88 (95% CI 0.81–0.94) in diagnosis of HCC. Low monthly income was associated with lower odds of undertaking AFP. Thirty one percent of cirrhotic persons were Child–Pugh C, and 67.9% of HCC patients had advanced or terminal disease at presentation.ConclusionsOur findings emphasize the young age of ESLD patients in Ghana and the advanced nature at presentation. It highlights shortcomings in surveillance and the need for policies to address the burden and improve outcomes in Ghana.

Comparative evaluation of fibroscan, liver biopsy and non-invasive serum markers for assessment of hepatic fibrosis in chronic liver disease

Introduction: Chronic liver disease is a disease of the liver that lasts over a period of six months or more, involving a process of progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis.In this study, we have compared three main tools to assess liver fibrosis including fibroscan, liver biopsy and non-invasive biomarkers. Materials and Methods: Inthis prospective study, a total of 30 cases of chronicliver disease were included. Fibrosis stage was assessed using fibroscan. In liver biopsy, Grading of fibrosis was done by modified activity grading system and staging was done using Ishak staging system. Serum markers were analysed using various scoring systems including AST/ALT ratio (AAR), AST/platelet ratio index (APRI), FIB-4 index and Forn Index. The obtained results were analyzed and evaluated using chi square test and area under receiver operator characteristic curve (AUROC) using SPSS version 20. Results: A significant association was found between fibroscan and Ishak fibrosis stage (p 0.049), fibroscan and APRI (p 0.02) and FIB-4 and liver biopsy (p 0.03). AAR and Forn index did not have any significant association with either fibroscan (p 0.969 and 0.889) or liver biopsy (p 2.56 and 0.98). Conclusion: The accuracy of fibroscan in evaluating fibrosis is comparable to that of liver biopsy. Thus, liver biopsy can be replaced with fibroscan in the future. Though, the non-invasive biomarkers are useful in assessing fibrosis, a combination of these markers may perform better than each alone. Keywords: Chronic liver disease, Liver biopsy, Fibroscan, Non invasive biomarkers.

Noninvasive assessment of liver fibrosis in children with chronic hepatitis C: Shear wave elastography and APRI versus liver biopsy

Background and study aimsHepatitis C virus (HCV) is a major cause of chronic hepatitis. Although liver histopathological examination remains the reference standard for liver fibrosis assessment, noninvasive means of assessment such as shear wave elastography (SWE) and aspartate aminotransferase–platelet ratio index (APRI) have been developed to reduce the need for biopsy. We evaluated the efficacy of SWE and APRI versus liver biopsy for liver fibrosis assessment in children with chronic HCV infection. Patients and methodsFibrosis staging was performed in 46 children (35 boys, 11 girls; mean age: 15.52 ± 2.71 years) with liver biopsy-proven chronic HCV infection according to the METAVIR system. SWE was performed within 6 months of liver biopsy. APRI scores were calculated using data collected on the day of biopsy. ResultsEighteen children had no or mild fibrosis (<F2, 39.1%) and 28 had significant fibrosis (≥F2, 60.9%), with a significant difference between the corresponding mean APRI scores (0.43 ± 0.23 vs 1.26 ± 1.24; p = 0.043). The APRI scores exhibited a significant correlation with the METAVIR stage (r = 0.630; p < 0.001). The SWE values were significantly higher in those with significant fibrosis than in those with no or mild fibrosis (10.43 vs 4.26 kPa; p < 0.000). These values exhibited significant correlations with the METAVIR stage and APRI score (r = 0.863 and 0.544, respectively; both p < 0.001). For differentiating significant fibrosis, the sensitivity, specificity and positive and negative predictive values for an APRI cutoff value of 0.62 were 46.43%, 94.4%, 92.9% and 53.1%, respectively, and these values for an SWE cutoff value of 7.6 kPa were 55.88%, 100%, 100% and 44.4%, respectively. ConclusionIn the clinical assessment of children, the APRI score and SWE can help differentiate between no or mild fibrosis and significant fibrosis. The routine use of SWE and APRI may help decrease the number of liver biopsies performed.

Assessment of hepatic fibrosis and steatosis by vibration-controlled transient elastography and controlled attenuation parameter versus non-invasive assessment scores in patients with non-alcoholic fatty liver disease

BackgroundNon-alcoholic fatty liver disease (NAFLD) is regarded as the most common liver disease in the twenty-first century, and a condition leaving individuals at increased risk of extra-hepatic morbidity. Liver biopsy has long been regarded as the gold standard for diagnosis and prognostication of patients with NAFLD. However, due to its invasive nature and potential complications (e.g., bleeding), other methods for non-invasive laboratory and radiological assessment of hepatic steatosis and fibrosis in NAFLD have evolved and include scores such as AST/Platelet Ratio Index (APRI), Fibrosis-4 (FIB-4) score, NAFLD fibrosis score (NFS), and fatty liver index (FLI), in addition to radiological methods such as transient elastography (TE), which is a well-validated non-invasive ultrasound-based technique for assessment of hepatic fibrosis. Recently, novel development of controlled attenuation parameter (CAP) in TE allowed simultaneous assessment of hepatic steatosis. This provided a chance to assess both hepatic fibrosis and steatosis in the same setting and without any unwanted complications. This study aimed at assessing the role of TE and CAP versus other non-invasive assessment scores for liver fibrosis and steatosis in patients with NAFLD.ResultsThis study included 90 patients diagnosed with NAFLD based on abdominal ultrasonography, body mass index, and serum liver enzymes. All patients were assessed with TE and non-invasive scores (APRI score, FIB-4 score, NFS, and FLI). There was a highly significant positive correlation between fibrosis and steatosis grades assessed by TE and other non-invasive respective scores. Both TE and CAP achieved acceptable sensitivity and specificity compared to other non-invasive assessment methods.ConclusionsTE with CAP can be used as a screening method for patients suspected with NAFLD or patients without a clear indication for liver biopsy. CAP allows a non-invasive method of assessment of hepatic steatosis in patients with NAFLD.

Treatment of Hepatitis C Genotypes 1 to 5 in Sub-Saharan Africa Using Direct-Acting Antivirals.

There is limited knowledge of the use of direct acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) in sub-Saharan Africa. We prospectively evaluated individuals infected with HCV genotypes 1 to 5 in Addis Ababa, Ethiopia. Liver fibrosis was assessed by AST-platelet ratio index score and cirrhosis by imaging and laboratory values. All 164 individuals completed treatment. The majority of patients had genotype 4 (76%), and 19% of participants showed evidence of cirrhosis. Sustained virologic response (SVR) across all genotypes was 98.8%. In those with cirrhosis, SVR was 93.5% and in non-cirrhotics 100%. Our study demonstrates broad genotype successful treatment of HCV with DAAs in sub-Saharan Africa, demonstrating the feasibility of HCV elimination in resource-limited settings.

Utility of Serum Biomarker Indices for Staging of Hepatic Fibrosis Before and After Venesection in Patients With Hemochromatosis Caused by Variants in HFE

Hemochromatosis that is associated with variants in the homeostatic iron regulator gene (HFE) is characterized by intestinal absorption of iron and excessive body and hepatic iron stores; it can lead to hepatic fibrosis and cirrhosis. Fibrosis has been staged by analysis of liver biopsies, but non-invasive staging methods are available. We evaluated the ability of aspartate aminotransferase:platelet ratio index (APRI), the fibrosis-4 (FIB-4) index, and gamma-glutamyl transferase:platelet ratio (GPR) to assess hepatic fibrosis staging in subjects with HFE-associated hemochromatosis, using liver biopsy-staged fibrosis as the reference standard. We performed a retrospective, cross-sectional analysis of 181 subjects with HFE-associated hemochromatosis and hepatic fibrosis staged by biopsy analysis and available serum samples. We calculated APRI, FIB-4, and GPR at diagnosis for all 181 subjects and following venesection therapy in 64 of these subjects (7 subjects had follow-up biopsy analysis). We used area under the receiver operating characteristic curve (AUROC) analysis to assess the relationships between APRI score, FIB-4 score, and GPR and advanced (F3-F4) fibrosis and to select cut-off values. Hepatic fibrosis stage correlated with APRI score (r = 0.54; P < .0001), FIB-4 score (r = 0.35; P <.0001), and GPR (r = 0.36, P < .0001). An APRI score above 0.44 identified patients with advanced fibrosis with an AUROC of 0.88, 79.4% sensitivity, 79.4% specificity, and 81% accuracy. A FIB-4 score above 1.1 identified patients with advanced fibrosis with an AUROC of 0.86, 80% sensitivity, 80.3% specificity, and 81% accuracy. A GPR above 0.27 identified patients with advanced fibrosis with an AUROC of 0.76, 67.7% sensitivity, 70.3% specificity, and 69% accuracy. APRI score was significantly more accurate than GPR (P = .05) in detecting advanced fibrosis; there was no difference between APRI and FIB-4. Venesection treatment was associated with significant reductions in APRI (P < .0001) and GPR (P < .001), paralleling fibrosis regression observed in available liver biopsies. Post-venesection APRI identified 87% of subjects with advanced fibrosis that decreased to levels that indicate stage F1-F2 fibrosis. In a retrospective study of 181 subjects with HFE-associated hemochromatosis, we found that APRI and FIB-4 scores identified patients with advanced hepatic fibrosis with 81% accuracy. APRI scores might also be used to monitor fibrosis regression following venesection.

Hepatitis C Patients with Progress of Disease Severity: Biochemical and Immunological studies

Hepatitis C infection has become epidemic with a rapid increase in the number of patients. Hepatitis C has some streaking among which are; most cases don't correlate with the histological of the hepatic biopsies of these patients. The present study aims at investigating some biochemical and immunological aspects among patients varying in degree of disease severity. The study includes 112 subjects; 24 healthy control and 88 CHC patients, grouped as follows: Group I: (control group), Group II: compensated chronic liver disease (without cirrhosis), Group III: decompensated with liver cirrhosis and Group IV: hepatocellular failure; end stage liver. Results of the present study showed that serum aspartate and alanine transaminases (AST & ALT), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP) activities, total and direct bilirubin, globulin, AST/platelet ratio index (APRI), globulin/platelet ratio, tumor necrosis factor-α (TNF-a), interferon-g (IFN-g), interleukins (lL-2 & IL-4), immunoglobulins (lgA, IgM and IgG), concentrations were increased significantly in all CHC patients groups while, albumin, albumin/globulin ratio (AIG ratio), platelets count, multivariate disriminant analysis (MDA) (based on 4 variables, AST/ALT,platelets, ALP & albumin), were decreased significantly in all CHC patients groups compared to the control group. AST/ALT ratio increased in all groups except Group II. CD4+% was significantly low in Group III and Group IV, while CD8+% decreased significantly in Group II & Group IV. It was concluded that biochemical tests in combination with each other could diagnose serious pathological disorders. Furthermore, immune parameters possibly play a role in the degradation process of the liver. Although, immune system components contribute to the liver injury, they maintain low viral load in advanced stages.

Role of noninvasive tools for prediction of clinically evident portal hypertension in children.

Noninvasive tools (NITs) for predicting varices in children with portal hypertension (PHTN) are infrequently used. Eighty-five consecutive, treatment-naïve children with PHTN and 97 controls were enrolled study from July 2017 to November 2018. Each case was evaluated by esophagogastroduodenoscopy (EGD) and various NITs: platelet spleen size Z (PSZ), clinical prediction rule (CPR), King's variceal prediction rule (KVaPS), Splenic stiffness (SSM) and liver stiffness measurement (LSM) by point shear wave elastrography (pSWE). Had PHTN due to extra hepatic portal vein obstruction (EHPVO) and 70% due to cirrhosis [chronic liver disease (CLD)]. Sixty-five percent of PHTN cases had varices. Children with varices had lower platelet counts, lower albumin and larger spleens. SSM and LSM were significantly higher in cases as compared with controls. SSM was significantly higher in cases with varices than those without. SSM and LSM, at cutoffs of 3.8 and 3.2 kPa, respectively, discriminated PHTN cases from controls with an area under the curve (AUROC) of 0.67 (0.59-0.74). Both SSM and LSM predicted varices in CLD, but in EHPVO, only SSM predicted varices. SSM of 5.2 and 12.8 kPa, in CLD and EHPVO subgroups, respectively, had AUROC of 0.73 and 0.94 for variceal prediction. Blood-based NITs performed better in the CLD subgroup: aspartate aminotransferase platelet ratio index, CPR and KVPS predicted severity of PHTN with AUROC of 0.81, 0.92 and 0.93, respectively. Blood-based NITs outperform elastography for prediction of PHTN/varices in children with CLD. SSM by pSWE is a better predictor of varices than LSM, especially in the EHPVO subgroup.

Diagnostic Accuracy of Noninvasive Tests to Detect Advanced Hepatic Fibrosis in Patients With Hepatitis C and End-Stage Renal Disease

For patients with liver disease from hepatitis C virus (HCV) infection complicated by end-stage renal disease (ESRD), it is important to assess liver fibrosis before kidney transplantation. We evaluated the accuracy of non-invasive tests to identify advanced hepatic fibrosis in patients with HCV and ESRD. In a retrospective study, we collected data on ratio of aspartate aminotransferase:alanine aminotransferase (AST:ALT), AST platelet ratio index (APRI), FIB-4 score, fibrosis index score, and King's score from 139 patients with ESRD and HCV infection (mean age, 52.8 y; 76.3% male; 86.4% African American; 45.3% with increased level of ALT). Results were compared with findings from histologic analyses of biopsies (reference standard). The primary outcome was detection of advanced fibrosis, defined as either bridging fibrosis or cirrhosis. Area under the receiver operating characteristic (AUROC) curves were constructed and optimal cutoff values were determined for each test. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were calculated. We repeated the analysis with stratification for normal levels of ALT (≤ 35 U/L for men and ≤ 25 u/L for women) and increased levels of ALT. FIB-4 scores identified patients with advanced fibrosis with an AUROC of 0.71 (95% CI, 0.61-0.80), the King's score with an AUROC of 0.69 (95% CI, 0.58-0.80), and the APRI with and AUROC of 0.68 (95% CI, 0.59-0.79). The accuracy of these tests increased when they were used to analyze patients with increased levels of ALT. All tests produced inaccurate results when they were used to assess patients with normal levels of AST and ALT. In patients with ESRD and HCV infection, FIB-4 scores, King's scores, and the APRI identify those with advanced fibrosis with AUROC values ranging from 0.68-0.71. Accuracy increased modestly when patients with increased levels of ALT were tested, but the tests produced inaccurate results for patients with a normal level of ALT.

Ledipasvir/Sofosbuvir in Adolescents With Chronic Hepatitis C Genotype 4 With and Without Hematological Disorders: Virological Efficacy and Impact on Liver Stiffness.

Egypt has the highest prevalence of hepatitis C virus (HCV) infection. Anti-HCV antibodies were detectable in 3% of children in Upper Egypt. Our aim was to evaluate the efficacy of ledipasvir/sofosbuvir for chronic HCV genotype 4 in adolescents with/without hematological disorders and to determine the effect of sustained virological response (SVR) on liver stiffness. Sixty-five adolescents were recruited. There were 3 patient groups: group 1, 44 treatment-naive without hematological disorders; group 2, 6 previously treated; and group 3, 15 treatment-naive with hematological disorders. All patients received sofosbuvir 400 mg/ledipasvir 90 mg per day for 12 weeks. Serum HCV RNA levels were measured before treatment, at week 12, and at 12 weeks after the end of treatment (SVR12). Liver stiffness and the aspartate aminotransferase-platelet ratio index (APRI) score were estimated at baseline and at SVR12. SVR12 was 100%. At SVR12, there was a significant improvement in liver stiffness in all groups. The APRI score showed significant improvements in groups 1 and 3 (P < .001 and P = .004, respectively). The treatment was well tolerated, with minimal and self-limited side effects. Treatment of chronic HCV in adolescents using ledipasvir/sofosbuvir was effective, with a cure rate (at SVR12) of 100%. Significant improvement in liver stiffness was found in all groups.