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APRI, FIB4 guide esophageal varices screening in light of hemophilia, coinfection

The aspartate transaminase-platelet ratio index and Fibrosis-4 score were effective non-invasive markers to monitor fibrosis and correlated to the presence of esophageal varices in hemophilic patients coinfected with HIV and hepatitis C, according to a new study.

“The use of such non-invasive and simple markers to check liver fibrosis is especially important in hemophilic patients, in whom liver biopsies should be avoided because of the possible hemorrhagic complication,” the researchers wrote. “It appears that APRI and FIB4 are good indicators for monitoring not only liver fibrosis but also esophageal varices, and we therefore strongly recommend that endoscopy be carried out when patients show an APRI or FIB4 value over the cut-off value described in this study.”

Researchers enrolled 43 hemophilic patients coinfected with HIV and HCV in the study. Median patient age was 41 years (range, 29-66 years). At the time of examination, researchers classified 37 patients as Child-Pugh class A.

APRI and FIB4 were significantly correlated with the synthetic liver function and fibrosis markers, apart from total bilirubin level, as well as with the volumetric solution of the acoustic radiation force impulse imaging elastography. Both indices were significantly correlated to each other (P< 0.01; r=0.76), including the 29 cases without any varices (P< 0.01; r=0.67).

Eleven patients had esophageal varices with a severity grade of F1 and three patients with a grade of F2. The comparison of areas under receiver operating characteristic (AUROC) curves for the fibrosis indices showed superior diagnostic accuracy of APRI (AUROC = 0.729) and FIB4 (AUROC = 0.778) to detect esophageal varices that are more severe than grade F1.

The optimal APRI cut-off value of 0.85 and the FIB4 cut-off of 1.85 both accurately classified 30 patients as having esophageal varices with 71.4% sensitivity and 70% specificity. Nine patients were false-positive cases in both APRI and FIB4, while only four false-negative cases occurred in each index. Both were also significant indicators of esophageal varices risk factors, each with an odds ratio of 5.56.

“Our present findings indicate that not only are APRI and FIB4 effective markers for determining the severity of liver fibrosis, they are also feasible surrogate markers for monitoring esophageal varices,” the researchers wrote. “Accordingly, we strongly recommend that even for patients who are apparently doing well with good liver function, physicians should undertake endoscopy to check for esophageal varices when the patients show APRI or FIB4 values over the cut-off value.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.