Work

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

Year: 2025

Type: article

Abstract: 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.

Source: Annals of Hepatology

DOI: 10.1016/j.aohep.2025.102146

Authors: Martine A.M.C. Baven-Pronk, Camiel J.M. Marijnissen, Maaike Biewenga, Albert F. Stättermayer, Maarten E. Tushuizen, Bart van Hoek

Institutions: Leiden University Medical Center, Groene Hart Ziekenhuis, Medical University of Vienna

Language: English

Topic: Liver Diseases and Immunity

Subfield: Hepatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,500