Non-invasive fibrosis algorithms are clinically useful for excluding cirrhosis in prisoners living with hepatitis C

PloS One
Timothy PapalucaAlexander J Thompson

Abstract

Prison-based HCV treatment rates remain low due to multiple barriers, including accessing transient elastography for cirrhosis determination. The AST-to-platelet ratio index (APRI) and FIB-4 scores have excellent negative predictive value (NPV) in hospital cohorts to exclude cirrhosis. We investigated their performance in a large cohort of prisoners with HCV infection. This was a retrospective cohort study of participants assessed by a prison-based hepatitis program. The sensitivity, specificity, NPV and positive predictive value (PPV) of APRI and FIB-4 for cirrhosis were then analysed, with transient elastography as the reference standard. The utility of age thresholds as a trigger for transient elastography was also explored. Data from 1007 prisoners were included. The median age was 41, 89% were male, and 12% had cirrhosis. An APRI cut-off of 1.0 and FIB-4 cut-off of 1.45 had NPVs for cirrhosis of 96.1% and 96.6%, respectively, and if used to triage prisoners for transient elastography, could reduce the need for this investigation by 71%. The PPVs of APRI and FIB-4 for cirrhosis at these cut-offs were low. Age ≤35 years alone had a NPV for cirrhosis of 96.5%. In those >35 years, the APRI cut-off of 1.0 alone had a high NPV >...Continue Reading

References

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Jan 18, 2019·Journal of Hepatology·Timothy PapalucaAlexander Thompson
Apr 11, 2019·The Medical Journal of Australia·Timothy PapalucaAndrew R Lloyd

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Citations

May 16, 2021·The International Journal on Drug Policy·Sanam HaririReza Malekzadeh

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Methods Mentioned

BETA
biopsy
PCR

Software Mentioned

FibroScan
STATA

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