ASPARTATE TO PLATELETS RATIO INDEX (APRI TEST) AS A NON-INVASIVE MARKERFOR EVALUATION OF LIVER FIBROSISINPATIENTS WITH CHRONIC HCVAND HBV

Abstract

The prognosis and management of chronic liver diseases greatly depends on the degree and progression of liver fibrosis. Until recently, liver biopsy was the only way to evaluate fibrosis in the liver. However, liver biopsy is an invasive and painful procedure, with rare but potentially life-threatening complications. Thus, many patients are reluctant to undergo liver biopsies, The accuracy of liver biopsy in assessing fibrosis has also been questioned in relation to sampling errors and intra- and interobserver variability that may lead to over- or understaging .Ideally, a noninvasive marker of liver fibrosis should be liver-specific, easy to perform, reliable, and inexpensive. In addition, it should be accurate not only for the grading of fibrosis, but also for the monitoring of disease progression and the efficacy of antiviral therapy. Liver stiffness was determined by transient elastography (Fibroscan), In brief an ultrasound transducer probe is mounted on the axis of a vibrator; vibrations of mild amplitude and low frequency induce an elastic shear wave that propagates through underlying liver tissue. Pulse-echo ultrasound acquisitions are used to follow propagation of the shear wave and measure its velocity. The harder the tissue the faster the wave. Results are expressed in kilopascals. All patients were studied using the non-invasive marker of (APRI TEST). APRI TEST was calculated according to the equation: {AST level of the patient (/ULN) X 100 divided by Platelet counts (109/L)}. *ULN = upper limit of normal AST (42 IU/L). *AST= aspartate transaminase.

In our study, we evaluated the effectiveness of APRI TEST in comparison to liver biopsy in chronic HCV & HBV patients, and we found that; [1] For diagnosis of Non- fibrotic patients (F0 & F1) and differentiating these stages from fibrotic patients (F2, F3 & F4 ), We found that, In HCV group, according to Cut off point (0.52) and the Mean ±SD (0.421 ± 0.068), APRI Test can be suitable to identify Non- fibrotic patients (F0 & F1) with Sensitivity, Specificity and diagnostic accuracy 78.1% , 100% and 87.3% respectively.

- In HBV group, we found that, according to Cut off point (0.40) and Mean ±SD (0.355 ± 0.041); APRI Test can differentiate non-fibrotic patients effectively with Sensitivity, Specificity and diagnostic accuracy of 91.2%, 100% and 93.1% respectively. [2] For diagnosis of cirrhosis and differentiation between cirrhotic patients (F4) and Non-cirrhotic patients (F0, F1, F2& F3) in HCV group, According to the Mean ±SD (1.396 ± 0.687), APRI Test can differentiate cirrhotic patients from non-cirrhotic very effectively, but, according to Cut off point (0.57), APRI Test is not suitable to identify cirrhotic patients (F4) with Sensitivity, Specificity and diagnostic accuracy of 100%, 56.2% and 85.9% respectively, - In HBV cirrhotic patients, we found that, according to Cut off point (0.8) and Mean ±SD (1.820 ± 0.865), APRI Test can moderately differentiate cirrhotic patients with Sensitivity, Specificity and diagnostic accuracy of 100%%, 73.3And 94% respectively.

[3] For identification of the target group of patients who will be included in programs of interferon therapy in HCV group; patients with significant fibrosis ( F2 & F3) were grouped and differentiated them from other groups., We found that, according to the Mean ±SD (1.006 ± 0.557) , APRI Test is moderately able to identify significant fibrosis (F2), but according to Cut off point (0.60), APRI Test is not suitable to identify significant fibrosis (F2) with Sensitivity, Specificity and diagnostic accuracy of 88.2%, 78.3% and 81.1% respectively. - Regarding significant fibrosis in HBV ,We found that, according to the Mean ±SD (1.215 ± 0.768), APRI Test is moderately able to identify significant fibrosis (F2), but according to Cut off point (0.76), APRI Test is not suitable to identify significant fibrosis (F2) with sensitivity 76%, specificity 933% and diagnostic accuracy 85.7% Therefore, APRI TEST is an easy and quick clinical non-invasive method to perform. Results are available immediately, and this technique is not appropriate for use in assessing the progression of fibrosis and determining the ideal time for initiating antiviral treatment in both CHC & CHB patients because of its moderate to low sensitivity in detecting significant fibrosis and cirrhosis in CHC patients, and its moderate to low sensitivity in detecting significant fibrosis but it has better sensitivity to detect cirrhosis in CHB patients. Although it has better sensitivity with mild fibrosis in both CHC & CHB patients.