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    Patent Pending

    AST to Platelet Ratio Index (APRI)

    Determines the likelihood of hepatic fibrosis and cirrhosis in patients with hepatitis C.
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with hepatitis C being considered for liver biopsy to determine chance of fibrosis or cirrhosis.

    • TThe AST to Platelet Ratio Index (APRI) predicts fibrosis and cirrhosis in hepatitis C patients.
    • It offers a non-invasive way to predict which patients have cirrhosis without imaging or biopsy.

    Points to keep in mind:

    • Most experts recommend using the AST Platelet Ratio Index in conjunction with other non-invasive testing especially with intermediate values, as sensitivity and specificity may not be sufficient at these values.
    • Caution: If your laboratory has higher-than-typical upper limits of normal for AST this could alter diagnostic performance.

    There is no perfect method for predicting fibrosis and cirrhosis in HCV and the APRI uses commonly available laboratory values that may help avoid the need for liver biopsy. The FIB-4 Score may also be useful in these patients as well.

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    Next Steps
    Evidence
    Creator Insights
    Dr. Anna S. Lok

    From the Creator

    Why did you develop the APRI? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

    We developed the APRI to find a simple, no cost method to estimate liver fibrosis and cirrhosis severity that can be applied in any part of the world.

    What pearls, pitfalls and/or tips do you have for users of the APRI? Do you know of cases when it has been applied, interpreted, or used inappropriately?

    APRI provides an estimation. It is not gospel, and users need to understand the limitations. For example, when the APRI result is discordant from other clinical data, one should consider repeating the assessment again during follow up, and take into account all available evidence. APRI has better negative predictive value than positive predictive value, i.e., low APRI is reliable in ruling out cirrhosis, but APRI is not very sensitive in identifying cirrhosis.

    What recommendations do you have for doctors once they have applied the APRI? Are there any adjustments or updates you would make to the score based on new data or practice changes?

    Knowing whether patients have advanced fibrosis or cirrhosis can determine urgency of treatment and need for cirrhosis care, e.g. HCC surveillance.

    How do you use the APRI in your own clinical practice? Can you give an example of a scenario in which you use it?

    If I see a patient in clinic with no biopsy, no decompensation, no imaging, no elastography, I can estimate in my head APRI as long as I have AST and platelet count, and can make good estimate of the stage of liver disease.

    With the advent of and increasing access to DAAs for hepatitis C, how close are we to eradicating the disease?

    We cannot eradicate hepatitis C until we have a vaccine, but we can eliminate it if we are able to find everyone who is infected and get them started on treatment.

    Any research you have in the pipeline that you’re particularly excited about?

    Prospects for HBV cure.

    About the Creator

    Anna S. Lok, MD, FAASLD, is a hepatology research professor and assistant dean for clinical research in the internal medicine department at the University of Michigan. She is also director of clinical hepatology at the University of Michigan Health System and the immediate past-president of the American Association for the Study of Liver Diseases. Dr. Lok’s research focuses primarily on the history and treatment of hepatitis B and C, hepatocellular carcinoma, and nonalcoholic fatty liver disease.

    To view Dr. Anna S. Lok's publications, visit PubMed

    Are you Dr. Anna S. Lok? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    About the Creator
    Dr. Anna S. Lok
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