Diagnostic value of the APRI index for liver fibrosis in a Chinese patients population with chronic hepatitis C acquired from blood transfusion 

Objective To evaluate the diagnostic efficacy of various newly developed non-invasive fibrotic predictive models based on measurements of common biochemical indices in a group of ethnic Chinese patients with long-standing chronic hepatitis C (CHC) infection acquired by transfusion.Methods Between July 2010 and June 2011, 120 of the monitored residents of Dingxi District of Gansu Province who had acquired hepatitis C infection via the regional practice of untested whole blood or plasma transfusion during the years of 1992-1995 were recruited for the current study.Each participant underwent liver biopsy for histological evaluation of liver fibrosis (S1-S4 progressive stages, from mild fibrosis to early cirrhosis) .Each participant also provided serum samples for biochemical measurement of fibrotic indicators, including hyaluronic acid (HA) , type Ⅲ procollagen protein (PCⅢ) , laminin (LN) , and type IV collagen (CⅣ) .In addition, aspartate aminotransferase (AST) , platelet count (PLT) , alanine aminotransferase (ALT) , prothrombin time (PT) , and international normalized ratio (INR) were measured to calculate the various non-invasive fibrotic predictive models: AST-to-PLT ratio index (APRI) , the Sheth index (AST/ALT) , the FibroQ index (10×[ (age×AST×PT INR) / (ALT×PLT]) , and the FIB-4 index ([age×AST) / (PLT×ALT1/2) ]) .Using the pathologic results as the reference standards, the diagnostic efficacies of these four non-invasive fibrotic predictive models were evaluated by Spearman's rank correlation coefficient.Accuracies of the four were compared by constructing receiver operating characteristic (ROC) curves and analyzing their sensitivities, specificities and area under the curves (AUCs) .Results The APRI, FibroQ and FIB-4 indexes, and the levels of PCⅢ, CⅣ, and HA increased in conjunction with progressive stages of liver fibrosis.However, only the APRI showed significant correlation to liver fibrosis stage (r=0.446, P<0.001) .The APRI index also had a better ability for distinguishing the moderatefibrosis stage from the severe fibrosis stage, as indicated by an AUC of 0.722, diagnostic sensitivity of 57.1%, and specificity of 78.2%.Conclusion APRI may be an effective and less traumatic alternative approach to surgical biopsy for diagnosing fibrosis, especially at stages greater than S2, in ethnic Chinese with CHC.