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APRI superior to FIB-4 in diagnosing cystic fibrosis liver disease in children

In a retrospective study, researchers found that biomarker aspartate aminotransferase to platelet ratio index was superior to Fibrosis-4 in differentiating between children with cystic fibrosis liver disease and children with cystic fibrosis without liver disease.

“This is the first liver biopsy-validated study of [aspartate aminotransferase to platelet ratio index] and FIB-4 in pediatric cystic fibrosis liver disease,” the researchers wrote.

Researchers evaluated the use of aspartate aminotransferase to platelet ratio index (APRI) and Fibrosis-4 (FIB-4) for predicting the degree of fibrosis in pediatric cystic fibrosis liver disease (CFLD) among 67 children with CFLD who had dual-pass liver biopsies and 104 age- and sex-matched children with CF without liver disease (CFnoLD).

“Receiver operating characteristic analysis and continuation ratio logistic regression were performed to assess the predictability of these biomarkers to distinguish CFLD from CFnoLD and determine fibrosis stage-specific cut-off values,” the researchers wrote.

Overall, the area under the receiver operator characteristic curve (AUC) for APRI was better (0.75) compared with FIB-4 in predicting CFLD (0.60; P = .005) and severe CFLD (0.81).

APRI had a sensitivity of 73.1% (95% CI, 60.9-83.2) and specificity of 70.2% (95% CI, 60.4-78.8) in predicting CFLD when the APRI score was greater than 0.264.

A 50% increase in APRI was associated with a 2.4-fold increased likelihood of having CFLD (95% CI, 1.7-3.3).

The researchers also observed that APRI was in agreement with histology staging 37% of the time; however, APRI was within one stage 73% of the time. FIB-4 predicted only portal hypertension at diagnosis, with an AUC of 0.91 (P < .001).

“APRI appears superior to FIB-4 in differentiating CFLD [vs.] CFnoLD,” the researchers wrote. “APRI also exhibited a high AUC in predicting severe liver fibrosis with specific cutoffs for lower stages.”

The researchers concluded: “This free, readily available biomarker can be used by a variety of CF providers across multiple disciplines to guide more advanced testing, such as imaging, screening endoscopy, and liver biopsy, longitudinally or identify patients who might be enrolled in future human trials of antifibrotic agents. Meanwhile, FIB-4 deserves further study as a potential noninvasive marker of [portal hypertension] in pediatric CFLD.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.