Indirect markers of fibrosis in chronic liver diseases: Is aspartate transaminase-to-platelet ratio (APRI) a useful test?

Indirect markers of fibrosis in chronic liver diseases: Is aspar-tate transaminase-to-platelet ratio (APRI) a useful test? Indirect markers of fibrosis in chronic liver diseases: Is aspartate transaminase-to-platelet ratio (APRI) a useful test? We read with great interest the article entitled " Noninvasive assessment of liver fibrosis with the aspartate transaminase to platelet ratio (APRI): Usefulness in patients with chronic liver disease " by Yilmaz Y et al. published in a recent issue of Hepatitis Monthly (1). In this study, the authors investigated the diagnostic power of APRI for predicting hepatic fibrosis in patients with chronic hepatitis B (CHB) and C (CHC) and non-alcoholic fatty liver disease (NAFLD). The study was retrospectively conducted on adults with chronic liver disease (CHB, CHC, or NAFLD) at the Department of Gastroenterology of Marmara University (Istanbul). Yilmaz et al. demonstrated that APRI was significantly associated with fibrosis scores in patients with CHC and NAFLD, but not in those with CHB. Interestingly, the analysis of the ROC curves highlighted that APRI was able to provide an acceptable prediction of the presence of liver fibrosis in patients with CHC (0.582, P < 0.01) and NAFLD (0.627, P < 0.01), but not in those with CHB (0.541, P = NS). Therefore, the authors concluded that APRI might be a useful test for the detection of liver fibrosis which develops in specific etiologies, including NAFLD and hepatitis virus C infection (1). APRI is one of the many indirect, non-invasive markers of hepatic fibrosis developed in recent years to avoid the use of liver biopsy, which, although still considered the gold standard for evaluation of fibrosis, is limited by its invasiveness, risk of complications, sampling errors, and variability in pathological interpretation. APRI is composed of panels that are routinely performed in patients with liver disease, and therefore, could be a practical and convenient way to follow patients. However, as demonstrated by Yilmaz et al., indirect markers such as APRI should be used with caution because their sensitivity in predicting fibrosis can be strongly influenced by the etiology of fibrosis. A relevant limitation of this study is that it was conducted in a tertiary liver centre, where the higher proportion of patients with advanced diseases might represent a selection bias with respect to a population observed in a more general setting. An additional limitation of APRI is represented by its inability to identify mild forms of liver fibrosis. In fact, aspartate …