APRI is not a Useful Predictor of Fibrosis for Patients with Chronic Hepatitis B

Liver biopsy remains the gold standard to assess hepatic fibrosis, including for those with chronic hepatitis B. The search for a novel, non-invasive alternative to liver biopsy to assess hepatic fibrosis continues. The serum aspartate-aminotransferase-to-platelet ratio index (APRI) has been shown to correlate with the degree of hepatic fibrosis in patients chronically infected with hepatitis C virus (CHC). The aim of this study was to investigate whether the same also applies in cases of chronic hepatitis B (CHB). One hundred and eleven consecutive patients who tested positive for hepatitis B surface antigen (HBsAg) for more than 6 months in our unit from July 2006 to June 2007 were included in the study. For all of the patients, platelet count, aspartate aminotransferase (AST), hepatitis B e antigen (HBeAg) by enzyme-linked immunosorbent assay (ELISA), hepatitis B virus (HBV) DNA by polymerase chain reaction (PCR), and percutaneous liver biopsy were tested for. APRI was calculated for every patient using the formula, AST x UNL x 100 / platelet count x 109/L. Patient characteristics, including APRI, were compared between those with a fibrosis? 2 and those having a fibrosis < 2. AST level was found to be higher in those with significant fibrosis (HAI-F > 2) and the proportion of HBeAg-positive patients was higher in those with a fibrosis ³ 2 (39%) compared to those with a fibrosis < 2. Only 3 patients out of 111 had an APRI > 1.5 and all of them had a fibrosis < 2. Liver biopsy remains the gold standard for assessment of fibrosis in chronic hepatitis and cirrhosis related to Hepatitis B infection. AST level was seen to differ among two groups, but no difference was seen for platelet counts. Although APRI has been shown to have good predictive value for significant fibrosis in patients with chronic hepatitis C infection, it does not appear to be of use in predicting fibrosis in patients with chronic hepatitis B infection.