George Trad, MD1, Karina Herrera, MD2, Robert Pattison, MD, MPH2, John Ryan, MD2, Syed AbdulBasit, MD2 1Mountainview Hospital, Las Vegas, NV; 2Southern Hills Medical Center, Las Vegas, NV
Introduction: Accuracy of diagnosing advanced hepatic fibrosis is an essential step for successful management of patients with liver disease. Many scoring systems has been proposed to help appropriately predict the level of hepatic fibrosis. Scoring systems such as AST/ALT score and APRI score have been compared head to head in the past. In an attempt to increase the predictability and differential accuracy of these non-invasive tests, we planned to combined AST/ALT and APRI scores. Our study attempted to evaluate whether combining AST/ALT score and APRI score will lead to a higher accuracy of identifying patients with advanced liver fibrosis.
Methods: We conducted a retrospective cohort study on patients who had presented to the single gastroenterology clinic who had obtained a Transient elastography (FibroScan) test. Patients were divided into two groups. Group one included patients with fibrosis score of F1 and F2. Group 2 included patients with fibrosis score of F3. AST/ALT score vs. APRI score vs. the combination of AST/ALT and APRI scores were compared head to head in each group.
Results: Total of 189 patients were identified. (Table 1) Severe Fibrosis was defined as a patient with a Fibrosis Score of 3 on FibroScan. Combining AST/ALT and APRI scores increased the sensitivity, positive likelihood ratio, positive productive value, negative productive value and accuracy compared to using AST/ALT score or APRI score alone.
Discussion: Our study demonstrates that combining AST/ALT and APRI scores result in higher accuracy of identifying patients with advanced liver fibrosis when it is compared to using AST/ALT score or APRI score alone. However, given our study is retrospective, additional randomized controlled studies are necessary to corroborate the beneficial effects of obtaining LDH in patients presenting with AP on admission.
Figure: Sensitivity of AST/ALT score vs. APRI score vs. Combination of both scores in patients with fibrosis score of 3 (severe fibrosis).
Statistic
AST/ALT score
APRI score
Combination of AST/ALT and APRI scores
Sensitivity
65.91%
52.27%
68.18%
Specificity
53.10%
84.83%
84.81%
Positive Likelihood Ratio
1.41
3.45
4.49
Negative Likelihood Ratio
0.64
0.56
0.38
Positive Predictive Value
29.92%
51.14%
57.69%
Negative Predictive Value
83.68%
85.40%
89.77%
Accuracy
56.09%
77.24%
80.94%
Table: Results of comparing AST/ALT score vs APRI score vs the combination of both AST/ALT and APRI scores.
Disclosures:
George Trad indicated no relevant financial relationships.
Karina Herrera indicated no relevant financial relationships.
Robert Pattison indicated no relevant financial relationships.
John Ryan indicated no relevant financial relationships.
Syed AbdulBasit indicated no relevant financial relationships.
George Trad, MD1, Karina Herrera, MD2, Robert Pattison, MD, MPH2, John Ryan, MD2, Syed AbdulBasit, MD2. A0478 - Combining Noninvasive Scores May Predict Patient With Advanced Liver Fibrosis More Accurately, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
