Use of Serum Aspartate Aminotransferase Levels and Platelet Count to Predict Hepatic Fibrosis in Chronic Hepatitis C

Abstract

Background: Chronic hepatitis C (CHC) induces inflammation resulting in fibrosis. Liver biopsy
is the gold standard for assessing histology. Progressive fibrosis results in portal hypertension,
splenomegaly, thrombocytopenia and decreased clearance with rise of the enzyme serum
aspartate aminotransferase (AST) levels. To amplify this difference in AST and platelet count in
fibrosis, AST-platelet-ratio-index (APRI) was devised using noninvasive serum markers,
suggesting that its application may decrease the need for liver biopsy.
Patients and Methods: Cross sectional descriptive study done in s i x t y HCV pos iti ve
patients fulfilling the criteria. AST levels (IU/L) expressed as a ratio of upper limit of normal (ULN)
9
taken as 40, were divided by platelet count (x10 /L) and multiplied by 100 to calculate
APRI = {(AST/40)/Platelet Count} x 100.
Liver biopsies were then staged by histopathologist for fibrosis according to Ishaq /revised
Knodell criteria.
Results: APRI of less than 1.5 was associated with absent or minimal fibrosis (F0-F2), whereas
values greater than these showed marked fibrosis/ cirrhosis (F3-F6) (p=0.0001).
Conclusion: Study showed that APRI has significant association with fibrosis and identifies CHC
patients with minimal as well as marked fibrosis and its application may decrease the need for
performing liver biopsies for staging