Platelet Ratio Index Score Research Articles

FIB-4 is closer to FibroScan screen results to detecting advanced liver fibrosis and maybe facilitates NAFLD warning.

To assess the relationship between clinical biochemical characteristics and steatosis or fibrosis by Fibroscan in non-alcoholic fatty liver disease (NAFLD) patients in order to seek the simple effective screening method closed to the results of the fibroScan measurement. A cross-sectional study was conducted on 188 patients with NAFLD who underwent FibroScan examinations. Demographic data and clinical biochemical characteristics were collected and analyzed. The result showed elevated serum uric acid (SUA) (P = .023, odds ratio [OR = 1.005, 95% CI (1.001-1.009) and metabolic syndrome (MetS) (P = .000, OR = 4.549, 95%CI (1.974-10.484) were associated with severe steatosis (controlled attenuation parameter, CAP ≥ 300 dB/m). The magnitude of liver stiffness measured using FibroScan was positively correlated with aspartate transaminase/alanine aminotransferase (AST/ALT) ratio (R = 0.419, P = .000), AST to platelet ratio index (APRI) score (R = 0.309, P = .000), and Fibrosis-4 score (FIB-4) (R = 0.507, P = .000). The areas under the receiver operating curve (ROC) of AST/ALT, APRI, and FIB-4 for mild or severe fibrosis were 0.563, 0.696, and 0.728, respectively, and those for advanced fibrosis were 0.648, 0.750, and 0.821, respectively. The FIB-4 index cutoff value was 1.65 with a sensitivity of 68.3% and specificity of 89.8% during the diagnosis of advanced fibrosis. MetS and elevated SUA are associated with severe steatosis according to the CAP value screen, whereas FIB-4, as the fibrosis score method, is closer to the liver stiffness measurement results from FibroScan, which may facilitate early warning of NAFLD in the community or in remote areas.

Liver fibrosis score is associated with the mortality of traumatic brain injury patients.

The fibrosis-4 score is a marker of liver fibrosis and has been confirmed to be associated with the prognosis of various diseases. There is no study exploring the prognostic value of the fibrosis-4 score in traumatic brain injury (TBI) patients. We design this study to explore the association between the fibrosis-4 score and mortality from TBI. TBI patients from the Medical Information Mart for Intensive Care-III database were extracted for the study. Univariate and multivariate logistic regressions were sequentially performed to analyze the association between fibrosis-4 and mortality in TBI. The area under the receiver operating characteristic curve (AUC) was drawn to evaluate the prognostic value of fibrosis-4 and other scores. A total of 1018 TBI patients were included, with a 30-day mortality of 24.2%. Non-survivors had older age, lower Glasgow Coma Scale (GCS), and higher injury severity score (ISS) than survivors. The aspartate aminotransferase platelet ratio index (APRI) and fibrosis-4 score were significantly higher in non-survivors. Univariate logistic regression showed that age, GCS, ISS, white blood cell, hemoglobin, fibrosis-4 score, subarachnoid hemorrhage, and anticoagulants were associated with the mortality of TBI patients. Multivariate logistic regression presented that age, GCS, ISS, fibrosis-4 score, subarachnoid hemorrhage, and anticoagulants were independent risk factors of mortality in TBI patients after adjusting for confounding effects. The AUC of the GCS, ISS, APRI, and fibrosis-4 score for predicting mortality was 0.711, 0.625, 0.592, and 0.627, respectively. Composed of age, GCS, ISS, fibrosis-4 score, subarachnoid hemorrhage, and anticoagulants, the predictive model had the highest AUC value of 0.790. The fibrosis-4 score is an independent risk factor for mortality in TBI. The model incorporating fibrosis-4 performs well in predicting the prognosis of TBI patients.

Antiviral use among hepatitis B infected patients in a low resource setting in Africa: a case study of West Nile, Uganda.

Failure to access antiviral medications is a leading cause of hepatitis B (HBV)-associated morbidity and mortality in sub-Saharan Africa (SSA). Despite guideline availability, SSA is not on course to meet its elimination targets. We characterized factors associated with antiviral medication use and challenges to offering chronic care in a large Ugandan institution. We abstracted HBV care data. 2,175/2,209 (98.5%) had HBV-infection. Most participants were men [1,197 (55%)]; median (IQR) age 27 years (19-35); 388/1689 (23.0%) had cirrhosis by sonography and 141/2175 (6.5%) by the aspartate aminotransferase to platelet ratio index (APRI) score ≥2. Of the eligible, 20/141 (14.2%) with APRI score ≥2 and 24/388 (6.2%) with sonographic evidence of liver cirrhosis were not on antiviral medications. Overall, 1,106 (51%) were on medications though 65.8% had not been fully investigated. In multivariate analysis, age ≥35 years [OR (95% CI) = 1.52 (1.01-2.28), p=0.043], APRI ≥2 [OR (95% CI) =1.79 (1.482.16), p<0.001], hepatitis B viral load >2,000IU/mL [OR (95% CI) = 6.22 (5.08-7.62), p<0.001] were associated with antiviral medications use. Over half of participants in care had not been fully evaluated although on treatment and many eligible patients did not access medications. There is need to bridge these gaps for SSA to realise its HBV elimination goals.

Assessment of Osteoporosis with Aspartate Aminotransferase to Platelet Ratio Index Score in Patients of Chronic Liver Disease

Objective: to assess Osteoporosis with APRI score (aspartate aminotransferase to platelet ratio index) in patients with chronic liver disease.&#x0D; Study Design: Cross-sectional study.&#x0D; Study Setting and Duration: Pak Emirates Military Hospital Rawalpindi, Pakistan from Jan to Dec 2021.&#x0D; Methodology: All Adult patients aged 18 years and above with clinical and imaging features suggestive of chronic liver disease were included in the study. APRI score calculated as the ratio of aspartate aminotransferase to platelet based on the laboratory analysis of Aspartate aminotransferase (AST) and platelet levels was done. Furthermore, a bone density scan (DEXA scan) was also carried out for all the study participants.&#x0D; Results: One hundred and sixty patients fulfilling the inclusion criteria were included. Of the total 160 cases, 53(33.1%) had normal bone density on DEXA scans, 43(26.9%) had Osteopenia and 64(40%) had Osteoporosis. Twenty-nine cases of chronic liver disease cases (25%) had APRI scores &lt;0.3, 40(25%) had APRI scores&gt;0.3 and&lt;0.5, 37 cases (23.1%) had APRI scores&gt;0.5 and &lt;1.5, 30 cases (18.8%) had APRI score &gt;1.5 and &lt;2 and 24 patients (15%) had APRI score &gt;2. The significant (p&lt;0.001) association was observed between APRI score and bone density, showing bone density decreased with the progression of the disease.&#x0D; Conclusion: Patients with chronic liver disease almost invariably develop Osteoporosis with the progression of the disease. Early recognition and treatment are pivotal to lessen morbidity and mortality associated with Osteoporosis.&#x0D; Keywords: Aspartate aminotransferase, Chronic liver disease, Hepatitis C, Osteoporosis, Osteopenia, Platelet.

Probiotic Supplementation, Hepatic Fibrosis, and the Microbiota Profile in Patients with Nonalcoholic Steatohepatitis: A Randomized Controlled Trial

BackgroundPromising results in improvement of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis (NASH) have been identified following probiotic (PRO) treatment. ObjectivesTo evaluate PRO supplementation on hepatic fibrosis, inflammatory and metabolic markers, and gut microbiota in NASH patients. MethodsIn a double-blind, placebo-controlled clinical trial, 48 patients with NASH with a median age of 58 y and median BMI of 32.7 kg/m2 were randomly assigned to receive PROs (Lactobacillus acidophilus 1 × 109 colony forming units and Bifidobacterium lactis 1 × 109 colony forming units) or a placebo daily for 6 mo. Serum aminotransferases, total cholesterol and fractions, C-reactive protein, ferritin, interleukin-6, tumor necrosis factor-α, monocyte chemoattractant protein-1, and leptin were assessed. To evaluate liver fibrosis, Fibromax was used. In addition, 16S rRNA gene-based analysis was performed to evaluate gut microbiota composition. All assessments were performed at baseline and after 6 mo. For the assessment of outcomes after treatment, mixed generalized linear models were used to evaluate the main effects of the group-moment interaction. For multiple comparisons, Bonferroni correction was applied (α = 0.05/4 = 0.0125). Results for the outcomes are presented as mean and SE. ResultsThe AST to Platelet Ratio Index (APRI) score was the primary outcome that decreased over time in the PRO group. Aspartate aminotransferase presented a statistically significant result in the group-moment interaction analyses, but no statistical significance was found after the Bonferroni correction. Liver fibrosis, steatosis, and inflammatory activity presented no statistically significant differences between the groups. No major shifts in gut microbiota composition were identified between groups after PRO treatment. ConclusionsPatients with NASH who received PRO supplementation for 6 mo presented improvement in the APRI score after treatment. These results draw attention to clinical practice and suggest that supplementation with PROs alone is not sufficient to improve enzymatic liver markers, inflammatory parameters, and gut microbiota in patients with NASH.This trial was registered at clinicaltrials.gov as NCT02764047.

Utility of AST to platelet ratio index (APRI) score in predicting post-surgical outcomes in patients with cholangiocarcinoma.

502 Background: Cholangiocarcinoma (CCA) is an epithelial malignancy of the intrahepatic or extrahepatic biliary tree, primarily driven by chronic inflammation and fibrosis. Given fibrosis has shown to correlate with malignancy and the aminotransferase-platelet ratio index (APRI) score, a marker for hepatic fibrosis, has shown to be useful in prognosticating hepatocellular carcinoma, this study aimed to assess the utility of APRI score in prognosticating post-surgical outcomes in CCA patients. Methods: 152 CCA patients at the Mayo Clinic that underwent surgical resection were retrospectively analyzed. Statistical analyses were then conducted to determine the relationship between APRI score and demographic factors, laboratory values (CA19-9, albumin, bilirubin, INR, alkaline Phosphatase, ALT, AST, and platelet count), pathology features, and outcome data. Results: When looking at demographic factors, no relationship between APRI score and age (r = -0.19, p = 0.02), sex (2-sample t-test p = 0.16) and race (ANOVA p = 0.81) were identified. There was a negative correlation between APRI score and albumin (m = -0.35, r = -0.35, p &lt; 0.01) and a positive correlation with bilirubin (m = 0.13, r = 0.23, p = 0.01) and ALT (m = 0.01, r = 0.47, p &lt; 0.01). No correlation between the other laboratory values analyzed was identified. Similarly, there was no relationship between APRI score and pathology features (tumor grade t-test p = 0.41, N Stage ANOVA p = 0.94, Vascular Invasion t-test p = 0.59, and Perineural invasion t-test p = 0.14), except for T3 stage which had a higher APRI score compared to T1, T2, and T4 (ANOVA p = 0.01). Likewise, APRI also did not correlate with post-surgical outcomes like recurrence (t-test p = 0.22) and mortality (t-test p = 0.39). Conclusions: In summary, despite being driven by chronic inflammation, APRI score, a marker for hepatic inflammation and a surrogate for liver fibrosis, did not serve as a reliable prognostication tool of post-surgical outcomes in CCA patients. These data suggest that although chronic inflammation is thought to be one of the primary drivers of disease, the role of other factors such as genetic and cellular signaling abnormalities may play a more prominent role in patients with CCA. In conclusion, APRI score did not serve as a useful prognostication tool in surgically resected CCA patients. Future studies should focus on other prognostic factors such as genomic and transcriptomic biomarkers in CCA.

Longitudinal analysis of transplant candidates with primary sclerosing cholangitis in an Asian liver transplant center.

Primary sclerosing cholangitis (PSC) is a rare disease in Asia, and few studies have investigated the disease in this ethnicity, particularly in wait-listed patients for liver transplantation (LT). We aimed to investigate the prognostic factors and outcomes of wait-listed patients with PSC in an Asian transplant center. Survival was retrospectively analyzed. Eighteen (10 male and 8 female) wait-listed patients with PSC, with a median age at diagnosis of 44.5 years, were included. Compared with men, women had significantly higher aspartate aminotransferase to platelet ratio index scores (3.28 vs. 1.13; P = 0.012) and bilirubin levels (7.68 vs. 4.03 mg/dl; P = 0.043) and more often presented with decompensating events, including ascites [5 (63%) vs. 1 (10%); P = 0.043] and splenomegaly [8 (100%) vs. 4 (40%); P = 0.013]. Compared with the non-LT group, the LT group exhibited a superior survival rate for women ( P = 0.004) but not for men. In the univariable analysis, significant risk factors associated with overall survival included malignancies with a hazard ratio (95% confidence interval) of 5.53 (1.00-30.51) and esophageal varices (EV) [4.18 (1.05-16.61)], whereas female gender [25.00 (1.49-500.00)], LT [0.09 (0.01-0.80)] and EV [39.03 (2.92-521.96)] were indicated in the multivariable analysis. For Asian wait-listed patients with PSC, EV and female gender were the risk factors related to overall survival, and LT was the protective factor. Our experiences suggested that LT brings more benefits in female patients. Strategies are needed to provide equivalent transplant benefits.

Correlation of serum markers with FibroScan® liver for assessment of hepatic fibrosis in patients with non-alcoholic steatohepatitis

Abstract Background: Newer non-invasive modalities such as FibroScan and laboratory testing methods such as aspartate aminotransferase (AST) platelet ratio index (APRI) scores, AST/alanine aminotransferase (ALT) ratio and fibrosis-4 (FIB-4) scores are being used for fibrosis assessment in non-alcoholic fatty liver disease (NAFLD) patients where facilities for liver biopsy are lacking. We studied the relationship between FibroScan® scores and serum fibrosis markers in non-alcoholic steatohepatitis (NASH) patients. Methods: One hundred patients who had undergone FibroScan of the liver over the past 2 years were enrolled. Demographic data were collected along with serum ALT, serum AST and platelet counts. The AST/ALT ratio, APRI score and FIB-4 were compared with the FibroScan fibrosis scores. Correlate between the degree of fibrosis in relation to age, platelet counts, serum ALT, serum markers and FibroScan scores was studied. Results: A significant positive correlation was noted between the FibroScan® results and the AST/ALT ratio, the APRI score and the FIB-4. No significant correlation was noted between age and fibrosis score. There was a highly significant correlation between platelet count and stiffness score. Conclusions: Our observations suggest that FibroScan®, along with the serum fibrosis markers, is helpful in assessing liver fibrosis in NASH patients, eliminating the need for liver biopsy in resource-poor settings.

The Relationship between TSH Levels, Thyroid Autoantibodies and Atherogenic Index of Plasma, AST to Platelet Ratio Index Score, and Fibrosis 4 Index in Patients with Hypothyroidism

The Relationship between TSH Levels, Thyroid Autoantibodies and Atherogenic Index of Plasma, AST to Platelet Ratio Index Score, and Fibrosis 4 Index in Patients with Hypothyroidism

S1438 Incidence and Early Detection of Patients With Nonalcoholic Fatty Liver Disease: A QI Project

Introduction: Non-Alcoholic Fatty liver disease (NAFLD) is under-recognized in Primary care clinics. Early diagnosis in Primary care clinics is essential to help understand the magnitude of the burden and initiate measures to prevent its silent progression. With the rising incidence of NAFLD, it will soon become a major health care burden in the future. We aim to establish a screening algorithm for early detection of NAFLD and educate patients on primary preventive measures to avoid the development of cirrhosis from fatty liver. Methods: We created an algorithm that was tested in a cohort of patients recruited from the primary care center. Inclusion criteria: Presence of established Type two diabetes Mellitus (T2DM),Components of metabolic syndrome like BMI >27, CAD and dyslipidemia etc, Elevated Liver Enzymes or history of fatty liver by any imaging modality. Exclusion criteria : Alcoholics, known liver disease from other causes. Clinical and demographic data collected were age, sex, BMI, comorbidities, and lab results to calculate Fibrosis-4 and AST to Platelet Ratio Index (APRI) Scores. Patients with FIB-4 score greater than 1.45 and APRI score greater than 0.7 were instructed to get Fibroscan. Results: Between August 2020 and October 2021, 203 patients were screened in the primary care clinic for NAFLD. A total of 51 patients met the inclusion and exclusion criteria. A total of 7 people (13%) had insufficient data. The median age in our study was 60 years. In terms of comorbidities, 52 % had T2DM, 77 % had hypertension, 52 % had hyperlipidemia, and the median for the BMI over 30.9. 9% had APRI score between 0.7 and 0.99, and 16% had an APRI score of > 1. 34% of our patients had their FIB-4 index between 1.45 and 3.25 and the remaining 16% had a FIB-4 index more than 3.25. A total of 26 patients had a Fibroscan to determine the stage. The Kpa ranges between 5.3-7.2 and the CPA ranges between 246 and 361 dB/m. Patients with high APRI and FIB-4 score and abnormal fibroscan results are referred to Liver clinic for further management. (Figure) Conclusion: This study demonstrates that a stepwise prospective application of an algorithm using inclusion and exclusion criteria in clinical practice settings can lead to the early identification of patients with NAFLD. Increasing awareness among health care providers to implement screening strategies in Clinics is necessary. Further studies on implementation in larger size populations are needed along with education and long-term management of these patients. (Table)Figure 1.: Algorithm followed for the study Table 1. - Demographic and Clinical data of the study Demographics Total Patients (44) Male, N (%) 22 (50) Age, (Median, IQR) 60, (54.5- 68) BMI, Median (IQR) 30.9, (27.97- 35.08) Comorbidities Hypertension N, (%) 34, (77) Diabetes N, (%) 23, (52) Dyslipidemia N, (%) 23, (52) Laboratory Parameters Aspartate Aminotransferase- U/L, (Median, IQR) 28 (19- 37) Alanine Aminotransferase- U/L, (Median, IQR) 27 (21- 44) Fibrosis Lab assessment FIB4 %(< 1.45, 1.45- 3.25, >3.25) 50, 34,16 APRI % (< 0.7, 0.7- 0.99, >1) 75, 9, 16 Non-Invasive imagingLiver Elastography (Range) 5.3- 7.2 kPa. 247- 361 CAP score (dB/m)

Aspartate aminotransferase to platelet ratio index (APRI) score: is it useful in patients with intrahepatic cholestasis of pregnancy?

Objective It is aimed to evaluate the efficacy of using aspartate aminotransferase (AST)/platelet count ratio [AST to platelet ratio index (APRI) score] in ICP patients. Methods This study was carried out including 101 patients diagnosed with ICP (72 patients with mild ICP and 29 patients with severe ICP). Laboratory tests and neonatal outcomes of both groups were analyzed retrospectively. APRI scores were compared between the two groups. Receiver operating characteristic (ROC) analysis was used to evaluate the performance of the APRI score in determining the severity of ICP and the prediction of adverse neonatal outcomes. p < .05 was considered to be a statistically significant result. Results Patients with severe ICP had higher APRI scores than patients with mild ICP (p < .001). The cutoff value for the APRI score was 1.06, with 82% sensitivity and 72% specificity. There was also a significant positive association between APRI score and fasting bile acid level (r = 0.445, p < .001). In addition, elevated APRI scores were associated with meconium-stained amniotic fluid, neonatal intensive care unit admission and preterm delivery. Conclusion The APRI score may not be the perfect differentiating method for the severity of ICP but it may help the clinician working with limited resources.

Karaciğer hastalıklarında kullanılan skorlamalar malign-benign kolestaz ayrımında kullanılabilir mi?

Giriş ve Amaç: Kronik safra yolu hastalıkları hepatositlerde bilirübin ve karaciğerden ekskrete edilen toksinlere daha uzun süre maruziyete neden olarak hepatosit fonksiyonlarını bozmaktadır. Ayrıca karaciğerin primer maligniteleri gibi safra yolu malignitelerinin de fibrotik karakterde olduğunu öne süren yayınlar vardır. Bu bilgiler ışığında kronik ve malign safra yolu tıkanıklığı oluşturan kolestatik hastalıkların, akut ve benign safra yolu tıkanıklığı oluşturan hastalıklara göre karaciğer fonksiyonlarını daha fazla bozduğu ve karaciğer fibrozisini artırdığı düşünülebilir. Çalışmamızda rutin testlerle ölçülebilen ve karaciğer hastalıklarında kullanılan skorlardan; R-faktör, son dönem karaciğer hastalığı modeli/sodyum, albümin-bilirübin skoru, albümin-alkalen fosfataz oranı, aspartat aminotransferaz-trombosit oran indeksi, dört faktörü temel alan fibrozis indeksi (fibrozis-4) ve gama glutamil transpeptidaz-trombosit oranı’ndan hangilerinin malign nedenli kolestaz tanısını koymakta yardımcı bir yöntem olarak kullanılabileceğinin araştırılması hedeflenmiştir. Gereç ve Yöntem: Ondokuz Mayıs Üniversitesi Tıp Fakültesi Gastroenteroloji Kliniği’nde Temmuz 2019- Temmuz 2021 tarihleri arasında obstrüktif kolestaz tanısı alan hastaların dosyaları retrospektif olarak tarandı. Akut ve benign nedenli kolestaz tanısı alan hastalar Grup 1, kronik ve malign nedenli kolestaz tanılı hastalar Grup 2 olarak sınıflandırıldı. Hastaların ilk başvuru zamanındaki laboratuvar değerleri kullanılarak; R-faktör, son dönem karaciğer hastalığı modeli/sodyum, albümin-bilirübin skoru, albümin-alkalen fosfataz oranı, aspartat aminotransferaz-trombosit oran indeksi, fibrozis-4 indeksi ve gama glutamil transpeptidaz-trombosit oranı skorları hesaplandı, tanıları ile tanı anındaki skorları arasındaki ilişki değerlendirildi. Bulgular: Çalışmaya 116’sı erkek (%57.4), 86’sı kadın (%42.6) toplam 202 hasta dahil edildi. Grup 1’de 92 (%45.5), Grup 2’de 110 (%54.5) hasta yer almaktaydı. Grup 1 ve Grup 2 arasında demografik özellikler açısından anlamlı fark görülmedi. Grup 1’de sık görülen hastalıklar kolanjit, koledokolitiazis ve safra çamuru ile biliyer pankreatit iken Grup 2’de ise pankreas başı karsinomuydu. Değerlendirilen laboratuvar parametrelerinden alkalen fosfataz, total ve direkt bilirübin maligniteye işaret eden en önemli testlerdi (p &amp;lt; 0.001). Karaciğer hastalığı skorlarından R-faktör (p &amp;lt; 0.001), son dönem karaciğer hastalığı modeli/sodyum (p &amp;lt; 0.001) ve albümin-bilirübin skoru (p = 0.023) Grup 2, albümin-alkalen fosfataz oranı (p &amp;lt; 0.001), aspartat aminotransferaz-trombosit oran indeksi (p &amp;lt; 0.001) ve fibrozis-4 indeksi (p &amp;lt; 0.001) Grup 1 lehine anlamlıydı ancak gama glutamil transpeptidaz-trombosit oranı için her iki grup arasında anlamlı fark yoktu (p = 0.242). Tanı konma süreçleri içinde Grup 1’deki hastaların nihai tanıları çoğunlukla ultrasonografi ile konmakta iken (p &amp;lt; 0.001), Grup 2’deki hastalar bilgisayarlı tomografi ile tanı almaktaydı (p &amp;lt; 0.001). Sonuç: Çalışmamız kronik karaciğer hastalıklarında kullanılan skorlardan R-faktör, son dönem karaciğer hastalığı modeli/sodyum ve albümin-bilirübin skoru malign nedenli kolestatik hastalıkların tanısında, albümin-alkalen fosfataz oranı, aspartat aminotransferaz-trombosit oran indeksi ve fibrozis-4 indeksinin benign nedenli kolestatik hastalıkların tanısında yardımcı bir yöntem olarak kullanılabileceğini, gama glutamil transpeptidaz-trombosit oranının ise bu ayırımda kullanılamayacağını göstermektedir. Bu tip öngörücü skorlar, anamnez ve muayene bulguları ile birlikte yorumlanarak hastaların tetkik ve tedavi planlarının daha hızlı sağlanmasını kolaylaştırabilir.

Prevalence of Cirrhosis/Advanced Fibrosis Among HBsAg-Negative and HBcAb-Positive US Adults: A Nationwide Population-Based Study.

Evaluation of cirrhosis appears to be easily overlooked in the clinic for the HBsAg-negative (hepatitisB surface antigen-negative) and HBcAb-positive (hepatitisB core antibody-positive) population. Herein, we determine the prevalence of cirrhosis/advanced fibrosis among HBsAg-negative/HBcAb-positive US adults. Data came from the National Health and Nutrition Examination Survey (NHANES) 2001-2018. A total of 3115 HBsAg-negative/HBcAb-positive US adults were enrolled in this study. We assessed cirrhosis by using the Fibrosis-4 (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) score. Out of 50,201 NHANES adults, 45,087 were tested for HBcAb/HBsAg, of whom 3115 met the inclusion criteria (HBsAg-negative/HBcAb-positive with available data for FIB-4/APRI). The weighted proportion of HBsAg-negative/HBcAb-positive among US adults was 4.46% (95%CI 4.17-4.75%), affecting 9.87 million US adults. According to the results of the FIB-4, the weighted prevalence of cirrhosis/advanced fibrosis among HBsAg-negative/HBcAb-positive US adults was 3.76% (95%CI 2.80-4.72%), which corresponds to 371,112 (95%CI 276,360-465,864) HBsAg-negative/HBcAb-positive American adults who had already developed cirrhosis. Among those, cirrhosis/advanced fibrosis in the HBsAb-negative (hepatitisB surface antibody) group (6.28%, 95%CI 4.10-8.45%) was significantly higher than in the HBsAb-positive group (3.08%, 95%CI 2.07-4.08%). Results were similar when APRI was used. According to the FIB-4, 3.76% of HBsAg-negative and HBcAb-positive US adults had cirrhosis/advanced fibrosis, much higher than in the general population of the USA. Our data highlight the importance of cirrhosis screening in the HBsAg-negative/HBcAb-positive population to prevent advanced liver disease, especially in those who are HBsAb-negative.

A predictive model incorporating inflammation markers for high-grade surgical complications following liver resection for hepatocellular carcinoma

Systemic inflammation and immune deficiency predispose surgical patients to infection and adversely affect postoperative recovery. We aimed to evaluate the prognostic ability of inflammation and immune-nutritional markers and to develop a predictive model for high-grade complications after resection of hepatocellular carcinoma (HCC). This study enrolled 1431 patients undergoing liver resection for primary HCC at a medical center. Preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, prognostic nutritional index, Model for End-Stage Liver Disease score, Albumin-Bilirubin score, Fibrosis-4 score, and Aspartate Aminotransferase to Platelet Ratio Index score were assessed. Stepwise backward variable elimination was conducted to determine the factors associated with Clavien-Dindo grade III to V complications within 30-day postoperative period. The predictive model was internally validated for discrimination performance using area under the receiver operating characteristic curve (AUC). A total of 106 (7.4%) patients developed high-grade complications. Four factors independently predicted a high-grade postoperative complication and were integrated into the predictive model, including NLR (adjusted odds ratio: 1.10, 95% confidence interval [CI], 1.02-1.19), diabetes mellitus, extent of hepatectomy, and intraoperative blood loss. The AUC of the model was 0.755 (95% CI, 0.678-0.832) in the validation dataset. Using the cutoff value based on Youden's index, the sensitivity and specificity of the risk score were 59.0% and 76.3%, respectively. Preoperative NLR independently predicted a high-grade complication after resection of HCC. The predictive model allows for identification of high-risk patients and appropriate modifications of perioperative care to improve postoperative outcomes.

A prospective study of the correlation between hepatic fibrosis and noninvasively measured fibrosis markers including serum M2BPGi and acoustic radiation force impulse elastography

Background: Mac-2 binding protein glycosylation isomer (M2BPGi) was introduced as a noninvasively measurable serologic marker for liver fibrosis. Acoustic radiation force impulse imaging (ARFI) elastography is another noninvasive method of measuring hepatic fibrosis. There are limited data about the correlations between histologic fibrosis grade and noninvasively measured markers, including M2BPGi and ARFI.Methods: This prospective study was conducted among patients admitted consecutively for liver resection, cholecystectomy, or liver biopsy. ARFI elastography, serum M2BPGi levels, and the AST to Platelet Ratio Index (APRI) score were evaluated before histologic evaluation. Histologic interpretation was performed by a single pathologist using the METAVIR scoring system.Results: In patients with high METAVIR scores, M2BPGi levels and ARFI values showed statistically significant differences between patients with fibrosis and those without fibrosis. In 41 patients with hepatocellular carcinoma, as METAVIR scores increased, M2BPGi levels also tended to increase (p=0.161). ARFI values changed significantly as METAVIR scores increased (p=0.039). In 33 patients without hepatocellular carcinoma, as METAVIR scores increased, M2BPGi levels significantly increased (p=0.040). ARFI values also changed significantly as METAVIR scores increased (p=0.033). M2BPGi levels were significantly correlated with ARFI values (r=0.604, p&lt;0.001), and APRI values (r=0.704, p&lt;0.001), respectively. Conclusions: Serum M2BPGi levels increased with liver fibrosis severity and could be a good marker for diagnosing advanced hepatic fibrosis regardless of the cause of liver disease.

Aspartate Aminotransferase to Platelet Ratio Index Score in Correlation with Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio to Predict Hepatic Cirrhosis in Hepatitis C Patients

Background: Tissue biopsy examination which is an invasive procedure has become the mainstay for hepatic cirrhosis identification in patients with hepatitis. Alternatively, noninvasive method using the aspartate aminotransferase (AST) to platelet ratio index (APRI) score has been developed to predict hepatic cirrhosis. Furthermore, the neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) have been used to predict the severity of hepatitis C. This study aimed to analyze the relationship between APRI scores and NLR and PLR in chronic hepatitis C patients. Methods: This correlative cross-sectional observational study used secondary data of complete blood counts such as neutrophil, lymphocyte, and platelet values, as well as AST values of patients with hepatitis C in the outpatient and inpatient installation of Dr. Hasan Sadikin General Hospital during 2019. The inclusion criteria were patients aged ≥18 years, male and female, who were diagnosed as hepatitis C patients, patients who had AST examination data, leukocytes, count type, and platelets. Data were analyzed using the Spearman rank correlation test. Results: The 123 subjects were dominantly male with an age range of 46–55 years. There was no correlation between the APRI and NLR scores (p=0.229). However, there was a moderate and significant negative correlation between APRI and PLR scores with a correlation coefficient of -0.468 (p=0.000). Conclusion: There is a significant negative correlation between APRI and PLR scores to predict the occurrence of hepatic cirrhosis in patients with Hepatitis C.

A Study on FibroScan and Endoscopic Finding in Patients of Chronic Liver Disease attending Tripura Medical College and Dr. B.R. Ambedkar Memorial Teaching Hospital.

Chronic liver disease (CLD) represents different liver disorders of varying severity and etiology in which hepatic inflammation and fibrosis continue at least for 6 months. Portal hypertension is one of the important complications of CLD and its early recognition is of paramount importance. Though liver biopsy remains the gold standard for diagnosing liver fibrosis and upper gastrointestinal (GI) endoscopy plays an important role in diagnosing different findings of portal hypertension, various noninvasive methods like FibroScan are being increasingly used to diagnose liver fibrosis. Study the FibroScan and endoscopic findings in patients of CLDs and the objectives are to find the prevalence of portal hypertension and to find various grades of esophageal varix and portal hypertensive gastropathy (PHG) and its relationship with liver fibrosis by FibroScan. A total of 114 patients of CLD and compensated cirrhosis having childturcotte- pugh (CTP) stages A and B were included in the study fulfilling inclusion and exclusion criteria, after calculating the sample size of 100. All the patients underwent detailed history, physical and gastrointestinal examination. Complete blood count (CBC), liver function test (LFT), kidney function test (KFT), viral markers were done. Aspartate aminotransferase (AST) to platelet ratio index (APRI) score was calculated, liver fibrosis was estimated by FibroScan and evidence of portal hypertension was documented by upper GI endoscopy. Cutoff value of FibroScan, APRI score, and model for end-stage liver disease (MELD) score for portal hypertension was decided by receiver operating characteristic (ROC) curve. Alcoholic liver disease (ALD) was the most common cause (43%) of CLD closely followed by nonalcoholic fatty liver disease (NAFLD) in 42% cases followed by chronic viral hepatitis, 75% patients had evidence of portal hypertension with PHG being the most common followed by esophageal varix. F4 fibrosis was found in 73% of cases followed by F3, F2, and F1 fibrosis. FibroScan value of 12.2 kPa was predictive of presence of portal hypertension and value of 26.6 mm predicted the presence of large esophageal varices.

Hepatit B Enfeksiyonunda Karaciğer Histopatolojik Evreleri ile Albumin-Bilirubin Skoru Arasındaki İlişki

Aim: In this study, sensitivity and specificity of the albumin-bilirubin (ALBI) score were investigated to detect significant liver fibrosis, and these findings were then compared to fibrosis-4 (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) scores. Material and Methods: A total of 69 patients were included in the study. Of these patients, 54 (78.3%) were male and 15 (21.7%) were female. Serology, molecular analysis, biochemical parameters, and pathology results of the patients who underwent a liver biopsy due to a chronic hepatitis B virus (HBV) infection, were retrospectively evaluated. ALBI, APRI, and FIB-4 scores were calculated. To predict the fibrosis stage, F≥2 and F≥4, ALBI, APRI, and FIB-4 scores were investigated using the receiver operator characteristic (ROC) curve analysis. Results: The area under the ROC curve with 95% confidence interval (CI) for the ALBI, APRI, and FIB-4 scores were 0.613 (95% CI: 0.463-0.762, p=0.160), 0.658 (95% CI: 0.513-0.803, p=0.040), and 0.731 (95% CI: 0.570-0.891, p=0.004), respectively, to predict the F≥2, and 0.758 (95% CI: 0.544-0.971, p=0.090), 0.604 (95% CI:0.451-0.757, p=0.490), and 0.923 (95% CI: 0.856-0.990, p=0.005), respectively, in prediction of F≥4. The sensitivity and specificity rates of the ALBI score were 61.1% and 64.7%, respectively, for the cut-off value of -2.81 in predicting F≥2, and 75.0% and 70.8% for the cut-off value of -2.78 in predicting F≥4. Conclusion: ALBI scores can be used to detect F≥2 in patients with chronic HBV. However, it is not yet clear whether this approach is superior to other non-invasive methods for detecting F≥4.

Correlation between Fibroscan and laboratory tests in non-alcoholic fatty liver disease/non-alcoholic steatohepatitis patients for assessing liver fibrosis.

BACKGROUNDNon-alcoholic fatty liver disease (NAFLD) is a spectrum of disease ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), through to advanced fibrosis and cirrhosis. Many patients with NAFLD remain undiagnosed and recognizing those at risk is very crucial. Although liver biopsy is the gold standard method for diagnosing and staging NAFLD, non-invasive imaging and lab modalities are also very promising in diagnosing these diseases.AIMTo explore some of these non-invasive modalities in this context and assess how they hold up in terms of making a diagnosis while avoiding an invasive procedure like a liver biopsy.METHODSThis study was conducted on NAFLD/NASH patients (n = 73) who underwent Fibroscan examinations at Saint George Hospital University Medical Center over 17 mo in order to assess liver fibrosis. Obtained Fibroscan results were correlated to laboratory tests and calculated aspartate transaminase (AST)/alanine transaminase (ALT) ratio, AST platelet ratio index (APRI) score and Fibrosis-4 score.RESULTSA significant age difference was observed across fibrosis stages of investigated patients. The mean stiffness score was 9.48 ± 11.77 KPa. A significant negative correlation was observed between ALT, AST, Albumin, gamma-glutamyl transferase, cholesterol, LDL, HDL, triglycerides, and ALP when compared across fibrosis stages. On the other hand, a significant positive correlation was found between Bilirubin, PT INR, partial thromboplastin time, glucose, and Platelet count when compared across fibrosis stages, in addition to AST/ALT ratio, APRI, and Fib-4 scores.CONCLUSIONThis study showed that Ultrasound alone is not efficient in the assessment of advancement of liver disease. Furthermore, the high positive relation between AST/ALT ratio, APRI and Fib-4 scores with fibrosis stages in NAFLD patients suggests that they could be used clinically in combination with Fibroscan to predict significant fibrosis and cirrhosis and to avoid liver biopsy.

Can First-trimester AST to Platelet Ratio Index Scores Predict HELLP Syndrome?

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