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Non-invasive fibrosis algorithms are clinically useful for excluding cirrhosis in prisoners living with hepatitis C
journal contributionposted on 03.12.2020, 04:03 by T Papaluca, A Craigie, L McDonald, A Edwards, M MacIsaac, JA Holmes, M Jarman, T Lee, H Huang, A Chan, M Lai, Vijaya Sundararajan, JS Doyle, M Hellard, M Stoove, J Howell, P Desmond, D Iser, AJ Thompson
BACKGROUND AND AIMS: Prison-based HCV treatment rates remain low due to multiple barriers, including accessing transient elastography for cirrhosis determination. The AST-to-platelet ratio index (APRI) and FIB-4 scores have excellent negative predictive value (NPV) in hospital cohorts to exclude cirrhosis. We investigated their performance in a large cohort of prisoners with HCV infection. METHODS: This was a retrospective cohort study of participants assessed by a prison-based hepatitis program. The sensitivity, specificity, NPV and positive predictive value (PPV) of APRI and FIB-4 for cirrhosis were then analysed, with transient elastography as the reference standard. The utility of age thresholds as a trigger for transient elastography was also explored. RESULTS: Data from 1007 prisoners were included. The median age was 41, 89% were male, and 12% had cirrhosis. An APRI cut-off of 1.0 and FIB-4 cut-off of 1.45 had NPVs for cirrhosis of 96.1% and 96.6%, respectively, and if used to triage prisoners for transient elastography, could reduce the need for this investigation by 71%. The PPVs of APRI and FIB-4 for cirrhosis at these cut-offs were low. Age ≤35 years alone had a NPV for cirrhosis of 96.5%. In those >35 years, the APRI cut-off of 1.0 alone had a high NPV >95%. CONCLUSION: APRI and FIB-4 scores can reliably exclude cirrhosis in prisoners and reduce requirement for transient elastography. This finding will simplify the cascade of care for prisoners living with hepatitis C.
TP received funding from an Australian Government Research Training Program Scholarship and the Department of Gastroenterology, St Vincent’s Hospital Melbourne. AJT and MH received funding from the National Health and Medical Research Council of Australia (NHMRC) Practitioner Fellowships 1142976 and 1112297. JH is funded by a University of Melbourne CR Roper Fellowship and a NHMRC program grant. This work was supported by NHMRC Program grant 1132902 and Partnership grant 1116161. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
- School of Psychology and Public Health