Modified AST to platelet ratio index improves APRI and better predicts advanced fibrosis and liver cirrhosis in patients with non-alcoholic fatty liver disease - 30/11/20

Doi : 10.1016/j.clinre.2020.08.006

Cheryl Huang ^a,^c, Jun Jie Seah ^a,^c, Chin Kimg Tan ^a, Jia Wen Kam ^a,^b, Jessica Tan ^a, Eng Kiong Teo ^a, Andrew Kwek ^a, Yu Jun Wong ^a, Malcolm Tan ^a, Tiing Leong Ang ^a, Rahul Kumar ^a,⁎
^a Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
^b Clinical Trials and Research Unit, Changi General Hospital, Singapore
^c NUS Yong Loo Lin School of Medicine, Singapore

^⁎Corresponding author at: Department of Gastroenterology and Hepatology, Changi General Hospital, 2 Simei Street 3, 529889 Singapore.Department of Gastroenterology and HepatologyChangi General Hospital2 Simei Street 3529889Singapore

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 30 November 2020
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Highlights

•	m-APRI, a non-invasive tool, can predict the presence or absence of advanced fibrosis and liver cirrhosis with accuracy.
•	m-APRI performs better than APRI and BARD in predicting both advanced fibrosis and liver cirrhosis in NAFLD.
•	The performance of m-APRI is similar compared to FIB-4 and NFS in NAFLD.
•	At cut-offs of 5.84 and 9 m-APRI is adequate for excluding advanced fibrosis and liver cirrhosis respectively in NAFLD.

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Abstract

Aims

Advanced fibrosis (AF) and liver cirrhosis (LC) are important milestones in non-alcoholic fatty liver disease (NAFLD). FIB-4, NFS and BARD are validated scores with good accuracy in detecting AF and LC. APRI does not have similar predictive accuracy. While a modification (m-APRI) improves its use in viral hepatitis, this has yet to be evaluated in NAFLD. This study compares diagnostic performance of aforementioned scores in predicting AF and LC in NAFLD.

Methods

Consecutive NAFLD patients undergoing Transient Elastography (TE) using Echosens® Fibroscan® for fibrosis staging were included. Cut-off liver stiffness measurements for AF and LC were 7.9 kPa and 11.5 kPa respectively. Anthropometric and laboratory tests done within 3 months were used. Diagnostic performances of scores were analyzed by standard statistical tests.

Results

161 patients qualified for the study. Mean age was 60.2 ± 14 years, BMI 26.8 ± 4.6 kg/m². M-probe was used in 113, XL in 48. Optimal cut-offs of m-APRI for AF and LC were 5.84 and 9 respectively. Area under receiver operator characteristic curves (AUROC) for prediction of AF at optimal cut-off points were m-APRI 0.84, APRI 0.80, FIB-4: 0.77, NFS 0.77 and BARD 0.65. For prediction of LC, AUROC were m-APRI: 0.83, APRI: 0.76, FIB-4: 0.81, NFS: 0.77 and BARD: 0.66. m-APRI was significantly superior to all scores compared in detecting AF (p < 0.05 for all) and superior to APRI (p = 0.008) and BARD (p = 0.007) in predicting LC. There was no significant difference between m-APRI and FIB-4 or NFS in prediction of LC.

Conclusions

For prediction of AF in NAFLD, m-APRI outperforms BARD, APRI, NFS and FIB-4, while for the prediction of cirrhosis, m-APRI is superior to APRI and BARD but comparable to NFS and FIB-4.

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Keywords : NAFLD, Liver fibrosis, Non-Invasive scores, m-APRI