Open AccessNon-invasive fibrosis algorithms are clinically useful for excluding cirrhosis in prisoners living with hepatitis C
Author(s) -
Timothy Papaluca,
A. L. Craigie,
Lawson McDonald,
Amy Edwards,
Michael MacIsaac,
Jacinta A Holmes,
Matthew Jarman,
Tanya Lee,
Huey W. Huang,
Andrew Chan,
Mark Lai,
Vijaya Sundararajan,
Joseph Doyle,
Margaret Hellard,
Mark Stoové,
Jessica Howell,
Paul Desmond,
David Iser,
Alexander Thompson
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0242101
Subject(s) - transient elastography , cirrhosis , medicine , hepatitis c , gastroenterology , retrospective cohort study , fibrosis , cohort , algorithm , hepatitis c virus , elastography , radiology , ultrasound , immunology , liver fibrosis , virus , computer science
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.