Annals of hepatology · 2025
Aspartate aminotransferase‑to‑platelet ratio index (APRI) reliably excludes advanced fibrosis and cirrhosis in treated autoimmune hepatitis.
СтатьяВалидационное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Baven-Pronk Martine A M C, Marijnissen Camiel J M, Biewenga Maaike, Stättermayer Albert F, Tushuizen Maarten E, van Hoek Bart
Аннотация
INTRODUCTION AND OBJECTIVES: Monitoring liver fibrosis during treatment of autoimmune hepatitis (AIH) is important to guide treatment. Transient elastography (TE) is not always available. Existing non-invasive fibrosis scores have been assessed primarily at diagnosis but not during treatment. This study aims to develop a non-invasive AIH fibrosis score (AIHFS) and validate its performance - alongside with existing fibrosis scores - for excluding advanced fibrosis (≥F3 on TE) and cirrhosis (F4 on TE) during AIH treatment.
PATIENTS AND METHODS: This study included adult patients with AIH and variant syndromes from Leiden (derivation cohort, n = 73) and Vienna (validation cohort, n = 81). All patients had been treated for at least 6 months and had valid TE and routine laboratory tests within 1 months of TE. Existing fibrosis scores were calculated and a novel AIHFS was developed using multivariate regression. TE served as the reference standard.
RESULTS: The aspartate aminotransferase-to-platelet ratio index (APRI) and AIHFS (comprising APRI and albumin) were the only fibrosis scores significantly associated with liver stiffness during treatment. AIHFS did not outperform APRI. APRI demonstrated a high negative predictive value for advanced fibrosis (≥F3 on TE) and cirrhosis (F4 on TE): 86 % and 93 % in the derivation cohort and 84 % and 95 % in the validation cohort, respectively. Based on an APRI threshold of 0.4874, only 22-40 % of patients would require further diagnostic assessment.
CONCLUSIONS: APRI is a simple, non-invasive, widely applicable score that reliably excludes advanced fibrosis (≥F3 on TE) and cirrhosis (F4 on TE) during AIH treatment, potentially reducing the need for additional investigations.
PATIENTS AND METHODS: This study included adult patients with AIH and variant syndromes from Leiden (derivation cohort, n = 73) and Vienna (validation cohort, n = 81). All patients had been treated for at least 6 months and had valid TE and routine laboratory tests within 1 months of TE. Existing fibrosis scores were calculated and a novel AIHFS was developed using multivariate regression. TE served as the reference standard.
RESULTS: The aspartate aminotransferase-to-platelet ratio index (APRI) and AIHFS (comprising APRI and albumin) were the only fibrosis scores significantly associated with liver stiffness during treatment. AIHFS did not outperform APRI. APRI demonstrated a high negative predictive value for advanced fibrosis (≥F3 on TE) and cirrhosis (F4 on TE): 86 % and 93 % in the derivation cohort and 84 % and 95 % in the validation cohort, respectively. Based on an APRI threshold of 0.4874, only 22-40 % of patients would require further diagnostic assessment.
CONCLUSIONS: APRI is a simple, non-invasive, widely applicable score that reliably excludes advanced fibrosis (≥F3 on TE) and cirrhosis (F4 on TE) during AIH treatment, potentially reducing the need for additional investigations.