Using AST-platelet ratio index and fibrosis 4 index for detecting chronic hepatitis C in a large-scale community screening

Yuan-Hung Kuo; Kwong-Ming Kee; Nien-Tzu Hsu; Jing-Houng Wang; Chang-Chun Hsiao; Yi Chen; Sheng-Nan Lu

doi:10.1371/journal.pone.0222196

Using AST-platelet ratio index and fibrosis 4 index for detecting chronic hepatitis C in a large-scale community screening

PLoS One. 2019 Oct 22;14(10):e0222196. doi: 10.1371/journal.pone.0222196. eCollection 2019.

Authors

Yuan-Hung Kuo^{1

2}, Kwong-Ming Kee¹, Nien-Tzu Hsu^{1

3}, Jing-Houng Wang¹, Chang-Chun Hsiao^{2

4}, Yi Chen⁵, Sheng-Nan Lu^{1

2

6}

Affiliations

¹ Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
² Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³ Biostatistics and Bioinformatics Center of Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁴ Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁵ Public Health Bureau, Tainan City Government, Tainan, Taiwan.
⁶ Division of Hepatogastroenterology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.

Abstract

Background: Aspartate transaminase-platelet ratio index (APRI) and fibrosis 4 (FIB-4) are two non-invasive indexes to predict liver fibrosis in liver disease. This study was to use APRI and FIB-4 to detect chronic virus hepatitis in community screenings.

Methods: From 2004 to 2013, a series of community-based health screenings for residents aged 40 and older were held in Tainan city. APRI and FIB-4 of each participant were calculated and their association further analyzed with hepatitis status.

Results: We enrolled 180359 participants including 18726 (10.4%) hepatitis B virus (HBV), 13428 (7.4%) hepatitis C virus (HCV), 1337 (0.7%) HBV plus HCV and 146868 (81.5%) Non-HBV Non-HCV. The prevalence of chronic HCV increased with the elevation of APRI cut-offs or FIB-4 cut-offs (13.9%, 28.1%, 38.8%, 45.2%, to 49.9% in APRI≥0.3, 0.5, 0.7, 0.9,1.1, p<0.001 for the linear trend; or 15.8%, 26.4%, 34.4% to 39.7% in FIB-4≥1.75, 2.75, 3.5, 4.25, p<0.001). At the township level, APRI≥ 0.7 and FIB-4≥ 3.5 were highly correlated with HCV infection (r = 0.95, p<0.001 in APRI and r = 0.809, p<0.001 in FIB-4) and hepatocellular carcinoma (HCC) development (r = 0.894, p<0.001 in APRI and r = 0.804, p<0.001 in FIB-4), but not correlated with HBV infection.

Conclusions: Community screenings derived APRI or FIB-4 can identify patient subsets with increased of underlying HCV infection and risk of incident HCC.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aspartate Aminotransferases / blood*
Blood Platelets / metabolism*
Carcinoma, Hepatocellular / blood*
Carcinoma, Hepatocellular / pathology
Carcinoma, Hepatocellular / virology
Female
Fibrosis / blood
Fibrosis / pathology
Hepacivirus / pathogenicity
Hepatitis B / blood
Hepatitis B / pathology
Hepatitis B / virology
Hepatitis B virus / pathogenicity
Hepatitis C, Chronic / blood*
Hepatitis C, Chronic / pathology
Hepatitis C, Chronic / virology
Humans
Liver Neoplasms / blood*
Liver Neoplasms / pathology
Liver Neoplasms / virology
Male
Middle Aged
Platelet Count

Substances

Aspartate Aminotransferases

Grants and funding

This study was supported by grants from Ministry of Science and Technology, Taiwan (NMRPD1D0481; NMRPD1E0401; NMRPD1F0131 & NMRPD1F0132) to S-NL and a grant from Chang Gung Memorial Hospital, Taiwan (CMRPG8F0072) to Y-HK. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.