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Diagnostic Performance of APRI and FIB-4 for Confirming Cirrhosis in Indonesian HIV/HCV Co-infected Patients
Evy Yunihastuti
Faculty of Medicine Universitas Indonesia
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6650-0559
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: After successful of antiretroviral therapy, highly effective direct acting antiviral (DAA) make HCV elimination reasonable in HIV/HCV co-infected patients. However, in achieving this target, there are still barriers to start DAA treatment, particularly in the area of liver fibrosis assessment that determine the duration of therapy. We aimed to assess the diagnostic performance of APRI and FIB-4 for diagnosing cirrhosis in HIV/HCV co-infected patients using hepatic transient elastography (TE) as gold standard.
Method: This is a retrospective study on HIV/HCV co-infected patients who concomitantly performed hepatic TE measurement, APRI, and FIB-4 evaluation before HCV treatment initiation at a tertiary hospital in Jakarta from 2014 to 2019. Sensitivity, specificity and diagnostic accuracy of indirect biomarkers for liver stiffness measurement (LSM) ≥ 12.5 kPa was determined by receiver operator characteristics curves.
Results: 223 HIV/HCV co-infected patients on stable antiretroviral therapy were included, of whom 91.5% were male with mean age of 37 (SD 5) years. Only 28.7% of patients were classified as cirrhosis (F4). Using TE as gold standard (≥12.5 kPa), the low threshold of APRI (1) had specificity 95%, sensitivity 48.4%, correctly classified 81.6% of patients, with moderate performance, AUC at 0.72 (95% CI 0.63-0.80). The optimal cut-off of FIB-4 was 1.66 [specificity 92.5%, sensitivity 53.1%, AUC at 0.73 (95% CI 0.65-0.81)] and correctly classified 81.1% of the patients.
Conclusion: APRI score > 1 and FIB-4 score > 1.66 had moderate performance with high specificity in diagnosing cirrhosis. These biochemical markers could be used while TE is not available.
Keywords
APRI, FIB-4, transient elastography, HIV, HCV
Figure 1
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On 23 Mar, 2020
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On 14 Mar, 2020
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Editorial decision: Major revision
On 28 Feb, 2020
Review #4 received
Received 27 Feb, 2020
Review #3 received
Received 18 Feb, 2020
Reviewer #4 agreed
On 10 Feb, 2020
Reviewer #3 agreed
On 07 Feb, 2020
Reviewer #2 agreed
On 06 Feb, 2020
Review #2 received
Received 06 Feb, 2020
Review #1 received
Received 04 Feb, 2020
Reviewer #1 agreed
On 21 Jan, 2020
Reviewers invited
Invitations sent on 14 Jan, 2020
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On 27 Dec, 2019
First submitted
On 26 Dec, 2019
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On 26 Dec, 2019
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This preprint is under consideration at BMC Infectious Diseases. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Diagnostic Performance of APRI and FIB-4 for Confirming Cirrhosis in Indonesian HIV/HCV Co-infected Patients
Evy Yunihastuti
Faculty of Medicine Universitas Indonesia
Corresponding Author
ORCiD: https://orcid.org/0000-0001-6650-0559
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 4
Posted 16 May, 2020
No community comments so far
Submission checks complete
On 08 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 29 Apr, 2020
Editor assigned
On 19 Apr, 2020
Submission checks complete
On 18 Apr, 2020
Editor invited
On 18 Apr, 2020
No comments provided
Editorial decision: Major revision
On 23 Mar, 2020
Editor assigned
On 15 Mar, 2020
Submission checks complete
On 14 Mar, 2020
Editor invited
On 14 Mar, 2020
No comments provided
Editorial decision: Major revision
On 28 Feb, 2020
Review #4 received
Received 27 Feb, 2020
Review #3 received
Received 18 Feb, 2020
Reviewer #4 agreed
On 10 Feb, 2020
Reviewer #3 agreed
On 07 Feb, 2020
Reviewer #2 agreed
On 06 Feb, 2020
Review #2 received
Received 06 Feb, 2020
Review #1 received
Received 04 Feb, 2020
Reviewer #1 agreed
On 21 Jan, 2020
Reviewers invited
Invitations sent on 14 Jan, 2020
Editor assigned
On 27 Dec, 2019
First submitted
On 26 Dec, 2019
Submission checks complete
On 26 Dec, 2019
Editor invited
On 26 Dec, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: After successful of antiretroviral therapy, highly effective direct acting antiviral (DAA) make HCV elimination reasonable in HIV/HCV co-infected patients. However, in achieving this target, there are still barriers to start DAA treatment, particularly in the area of liver fibrosis assessment that determine the duration of therapy. We aimed to assess the diagnostic performance of APRI and FIB-4 for diagnosing cirrhosis in HIV/HCV co-infected patients using hepatic transient elastography (TE) as gold standard.
Method: This is a retrospective study on HIV/HCV co-infected patients who concomitantly performed hepatic TE measurement, APRI, and FIB-4 evaluation before HCV treatment initiation at a tertiary hospital in Jakarta from 2014 to 2019. Sensitivity, specificity and diagnostic accuracy of indirect biomarkers for liver stiffness measurement (LSM) ≥ 12.5 kPa was determined by receiver operator characteristics curves.
Results: 223 HIV/HCV co-infected patients on stable antiretroviral therapy were included, of whom 91.5% were male with mean age of 37 (SD 5) years. Only 28.7% of patients were classified as cirrhosis (F4). Using TE as gold standard (≥12.5 kPa), the low threshold of APRI (1) had specificity 95%, sensitivity 48.4%, correctly classified 81.6% of patients, with moderate performance, AUC at 0.72 (95% CI 0.63-0.80). The optimal cut-off of FIB-4 was 1.66 [specificity 92.5%, sensitivity 53.1%, AUC at 0.73 (95% CI 0.65-0.81)] and correctly classified 81.1% of the patients.
Conclusion: APRI score > 1 and FIB-4 score > 1.66 had moderate performance with high specificity in diagnosing cirrhosis. These biochemical markers could be used while TE is not available.
Figure 1