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Non-invasive fibrosis algorithms are clinically useful for excluding cirrhosis in prisoners living with hepatitis C
Timothy Papaluca1, Anne Craigie1, Lucy McDonald1
1Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Melbourne, Australia.
Insights
Hepatitis C (HCV) cirrhosis can be reliably excluded in prisoners using the AST-to-platelet ratio index (APRI) and FIB-4 scores. These non-invasive markers can reduce the need for transient elastography, simplifying HCV care in correctional facilities.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Prison-based Hepatitis C Virus (HCV) treatment is hindered by barriers, including limited access to transient elastography for cirrhosis assessment.
- Non-invasive markers like the AST-to-platelet ratio index (APRI) and FIB-4 scores show promise in excluding cirrhosis in general populations.
Purpose of the Study:
- To evaluate the performance of APRI and FIB-4 scores in identifying cirrhosis among a large cohort of prisoners with HCV infection.
- To assess the potential of these scores to reduce the reliance on transient elastography in this population.
Main Methods:
- Retrospective cohort study of 1007 prisoners with HCV infection.
- Analysis of sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of APRI and FIB-4 for cirrhosis, using transient elastography as the reference standard.
- Exploration of age thresholds as a potential trigger for transient elastography.
Main Results:
- APRI (cut-off 1.0) and FIB-4 (cut-off 1.45) demonstrated high NPVs (96.1% and 96.6%, respectively) for cirrhosis.
- Utilizing these scores for triage could decrease the need for transient elastography by 71%.
- Age ≤35 years alone had a NPV of 96.5% for cirrhosis, and in individuals >35 years, APRI alone showed a high NPV (>95%).
Conclusions:
- APRI and FIB-4 scores are effective tools for excluding cirrhosis in the prison population.
- These non-invasive markers can significantly reduce the requirement for transient elastography, streamlining the care pathway for incarcerated individuals with HCV.
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.
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