Validation of three noninvasive laboratory variables to predict significant fibrosis and cirrhosis in patients with chronic hepatitis C in Saudi Arabia

BACKGROUND: We tested the clinical utility of the platelet count, the aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, and the AST to platelet ratio index (APRI) score in predicting the presence or absence of advanced fibrosis and cirrhosis in patients with chronic hepatitis C in Saudi Arabia. METHODS: Liver biopsy procedures performed on chronic hepatitis C patients in our gastroenterology unit at King Khalid University Hospital were traced from records between the years 1998 to 2003. The hospital computer database was then accessed and detailed laboratory parameters obtained. By plotting receiver operating characteristic curves (ROC), three selected models (platelet count, AST/ALT ratio, and the APRI score) were compared in terms of the best variable to predict significant fibrosis. RESULTS: Two hundred and forty-six patients with hepatitis C were included in this analysis. Overall, 26% of patients had advanced fibrosis. When comparing the three above-mentioned prediction models, the APRI score was the one associated with the highest area under the curve (AUC) = 0.812 (95% CI, 0.756–0.868) on the ROC curves, compared to the platelet count and AST/ALT ratio, which yielded an AUC of 0.783 (0.711–0.855) and 0.716 (0.642–0.789), respectively. CONCLUSION: The APRI score seemed to be the best predictive variable for the presence or absence of advanced fibrosis in Saudi hepatitis C patients.