Noninvasive liver fibrosis assessment: Why does the APRI not work for Hepatitis B? & Author's Reply

摘要

We read the article by Yilmaz et al. with interest (1). Chronic liver disease requires the regular assessment of fibrosis to risk-stratify patients to treat and monitor the complications of liver cirrhosis (2). Due to the overwhelming burden of liver disease worldwide, there is a patent need for noninvasive methods of assessing fibrosis to enable us to test large numbers of patients regularly. The aspartate transaminase-to-platelet ratio index (APRI) is valuable, primarily due its universal availability, simplicity, and, hence, ease of use (1). The reliability of the APRI in hepatitis C and nonalcoholic fatty liver disease (NAFLD), as reported by Yilmaz et al. should broaden its application in these conditions. As in many studies, APRI was less reliable for hepatitis B (3-5). Yilmaz et al. attribute the failure of APRI to adequately predict fibrosis to platelet count, claiming that both hepatitis C and NAFLD are associated with lower platelet counts than hepatitis B. In their own cohort, however, this was not the case, as the mean platelet counts were 224,714, 221,851, and 249,871 for hepatitis B, hepatitis C and NAFLD, respectively.