Novel non-invasive score to predict cirrhosis in the era of hepatitis C elimination: A population study of ex-substance users in Singapore

摘要

Background:Chronic hepatitis C infection is common among people with history of substance use.Liver fibrosis assessment is a barrier to linkage to care,particularly among those with history of substance users.The use of non-invasive scores can be helpful in predicting liver cirrhosis in the era of HCV elimination,especially in countries where transient elastography (TE) is not available.We compared the commonly used non-invasive scores with a novel non-invasive score in predicting liver cirrhosis in this population.Methods:HCV patients with history of substance use between 2011 and 2016 were analyzed.All patients had TE for liver fibrosis assessment.Clinical performance of established non-invasive scores for fibrosis assessment and novel score were compared.Youden's index was used to determine optimal cut-off of the novel score.Results:A total of 579 patients were included.In multivariate logistic regression,cirrhosis on TE was associated with age (P=0.002),aspartate aminotransferase (AST) (P=0.004),and platelet count (P ＜ 0.001),but not alanine aminotransferase (ALT) (P=0.896).These form the components of modified AST-toplatelet ratio index (APRI) score.Modified APRI was superior to APRI in predicting cirrhosis (AUROC,0.796 vs.0.770,P=0.007),but not fibrosis-4 score (FIB-4) (P=1.00).Modified APRI at cut-off of 4 has sensitivity,specificity and negative predictive value (NPV) of 94.4％,26.9％ and 92.6％,respectively,and at 19,has sensitivity,specificity and positive predictive value (PPV) of 33.3％,96.2％ and 77.1％,respectively.FIB-4 has a NPV and PPV of 88.6％,41.8％ and 78.5％,77.6％,at cut-off of 1.45 and 3.25,respectively.Using the cut-off of 4 and 14 for modified APRI,32.5％ of patients can be correctly classified and misses out only 5.6％ of cirrhosis patients.Conclusions:Modified APRI score is superior in predicting cirrhosis in HCV population,with 32.5％ of the population being correctly classified using cut-off of 4 and 14.Further studies are required to validate the findings.