A simple noninvasive index (APRI) predicts advanced liver fibrosis in children with chronic hepatitis B†
Notice bibliographique
Résumé
We read with interest the article by Wai et al.1 on the use of the aspartate aminotransferase to platelet ratio index (APRI) for the noninvasive diagnosis of liver fibrosis. The authors concluded that APRI can identify with a high degree of accuracy patients who have chronic hepatitis C with significant fibrosis, and application of this index may decrease the need for staging liver biopsy specimens among these patients. We therefore determined APRI after an overnight fast in 71 children (age range 4-17 years; mean age 10 years; mean alanine aminotransferase 83 IU/L) with biopsy-verified chronic hepatitis Be antigen– and HBV DNA–positive hepatitis B prior to antiviral treatment. Children infected with hepatitis C virus (HCV) and diagnosed liver cirrhosis were excluded from this study. Protocol was approved by the ethics committee of the Medical University of Bialystok. APRI was calculated according to Wai et al.1 Fibrosis stage was assessed in a blinded fashion according to Ishak et al.2 by a single pathologist. We defined advanced liver fibrosis as a score >2. Receiver-operating characteristics analysis was used to calculate the power of the index to detect advanced liver fibrosis (AccuROC, Accumetric Corp., Montreal, Canada). Thirty-four children (48%) had advanced fibrosis. The ability of APRI was significant (P = 0.0003) in differentiating children with advanced liver fibrosis from those with mild fibrosis: area under the curve (95% CI) = 0.748 (0.63-0.87); positive predictive value = 70.3%; negative predictive value = 76.5%. APRI > 0.59 had a sensitivity of 76.5% and a specificity of 70% (Fig. 1). Correct classification proportion of staging fibrosis was 73.2%; therefore, 52 of 71 children could be correctly allocated to either the group with mild or advanced fibrosis, potentially avoiding biopsy. Other serum parameters—e.g., aspartate to alanine aminotransferase ratio (AAR) or platelet count—yielded a lower predictive power (area under the curve = 0.395 and 0.346, respectively). Receiver-operating characteristic analysis of APRI in predicting advanced liver fibrosis according to Ishak et al.2 in children with chronic hepatitis B. Liver biopsy is thought mandatory for the management of patients with chronic hepatitis B virus (HBV) infection, especially for staging fibrosis. However, noninvasive markers that predict advanced fibrosis due to chronic hepaititis B in children are lacking, except in our previous studies. Among the panel of examined serum fibrosis markers (n = 11), only hyaluronan and laminin-2 accurately predicted the presence of advanced fibrosis.3-5 However, extracellular matrix components are not routinely used in clinical practice in contradiction to APRI, which can be calculated without additional blood collection or costs and is not influenced by body growth. Data regarding assessment of APRI in adults are also scarce. Our results are in agreement with the data presented by Wai et al.1 and Berg et al.,6 but Giannini and Testa,7 Le Calvez et al.,8 and Castera et al.9 found that AAR7 and Fibrotest8, 9 are more accurate than APRI for noninvasive assessment of significant fibrosis. The usage of different histological scoring systems, interobserver or intraobserver variability of the biopsies, and differences between the patient populations in these studies could be responsible for this disagreement. We conclude that APRI may be an accurate, inexpensive, and simple noninvasive index in predicting advanced liver fibrosis in children with chronic hepatitis B. Application of this index may decrease the need for liver biopsy in children with chronic hepatitis B, but further studies are urgently needed to confirm this finding. Dariusz M. Lebensztejn*, Elžbieta Skiba*, Maria Sobaniec-Lotowska , Maciej Kaczmarski*, * 3rd Department of Pediatrics, Medical University of Bialystok, Bialystok, Poland, Department of Clinical Pathomorphology, Medical University of Bialystok, Bialystok, Poland.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».