Background & Aims

For patients with liver disease from hepatitis C virus (HCV) infection complicated by end-stage renal disease (ESRD), it is important to assess liver fibrosis before kidney transplantation. We evaluated the accuracy of non-invasive tests to identify advanced hepatic fibrosis in patients with HCV and ESRD.

Methods

In a retrospective study, we collected data on ratio of aspartate aminotransferase:alanine aminotransferase (AST:ALT), AST platelet ratio index (APRI), FIB-4 score, fibrosis index score, and King’s score from 139 patients with ESRD and HCV infection (mean age, 52.8 y; 76.3% male; 86.4% African American; 45.3% with increased level of ALT). Results were compared with findings from histologic analyses of biopsies (reference standard). The primary outcome was detection of advanced fibrosis, defined as either bridging fibrosis or cirrhosis. Area under the receiver operating characteristic (AUROC) curves were constructed and optimal cutoff values were determined for each test. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were calculated. We repeated the analysis with stratification for normal levels of ALT (≤ 35 U/L for men and ≤ 25 u/L for women) and increased levels of ALT.

Results

FIB-4 scores identified patients with advanced fibrosis with an AUROC of 0.71 (95% CI, 0.61–0.80), the King’s score with an AUROC of 0.69 (95% CI, 0.58–0.80), and the APRI with and AUROC of 0.68 (95% CI, 0.59–0.79). The accuracy of these tests increased when they were used to analyze patients with increased levels of ALT. All tests produced inaccurate results when they were used to assess patients with normal levels of AST and ALT.

Conclusions

In patients with ESRD and HCV infection, FIB-4 scores, King’s scores, and the APRI identify those with advanced fibrosis with AUROC values ranging from 0.68–0.71. Accuracy increased modestly when patients with increased levels of ALT were tested, but the tests produced inaccurate results for patients with a normal level of ALT.

中文翻译：

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无创检测在丙型肝炎和终末期肾病患者中检测晚期肝纤维化的诊断准确性。

背景与目标

对于因丙型肝炎病毒 (HCV) 感染并发终末期肾病 (ESRD) 的肝病患者，在肾移植前评估肝纤维化非常重要。我们评估了非侵入性测试的准确性，以识别 HCV 和 ESRD 患者的晚期肝纤维化。

方法

在一项回顾性研究中，我们收集了 139 名 ESRD 和 HCV 感染患者的天冬氨酸转氨酶：丙氨酸转氨酶比值 (AST:ALT)、AST 血小板比值指数 (APRI)、FIB-4 评分、纤维化指数评分和 King's 评分的数据（平均年龄，52.8 岁；76.3% 男性；86.4% 非裔美国人；45.3% ALT 水平升高）。结果与活检组织学分析的结果（参考标准）进行比较。主要结果是检测到晚期纤维化，定义为桥接纤维化或肝硬化。构建接受者操作特征 (AUROC) 曲线下的面积，并确定每个测试的最佳截止值。计算敏感性、特异性、阳性和阴性预测值以及诊断准确性。

结果

FIB-4 评分确定晚期纤维化患者的 AUROC 为 0.71（95% CI，0.61-0.80），King's 评分的 AUROC 为 0.69（95% CI，0.58-0.80），APRI 和 AUROC 为 0.68 （95% CI，0.59–0.79）。当这些测试用于分析 ALT 水平升高的患者时，其准确性会提高。当它们用于评估 AST 和 ALT 水平正常的患者时，所有测试都会产生不准确的结果。

结论

在 ESRD 和 HCV 感染患者中，FIB-4 评分、King 评分和 APRI 可识别晚期纤维化患者，AUROC 值范围为 0.68-0.71。当对 ALT 水平升高的患者进行检测时，准确度略有增加，但对于 ALT 水平正常的患者，检测结果不准确。