Aspartate aminotransferase‑to‑platelet ratio index (APRI) reliably excludes advanced fibrosis and cirrhosis in treated autoimmune hepatitis.

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.