Non-invasive fibrosis algorithms are clinically useful for excluding cirrhosis in prisoners living with hepatitis C

Timothy Papaluca, Anne Craigie, Lucy McDonald, Amy Edwards, Michael MacIsaac, Jacinta A Holmes, Matthew Jarman, Tanya Lee, Hannah Huang, Andrew Chan, Mark Lai, Vijaya Sundararajan, Joseph S Doyle, Margaret Hellard, Mark Stoove, Jessica Howell, Paul Desmond, David Iser and Alexander J Thompson

PLOS ONE, 2020, vol. 15, issue 11, 1-11

Abstract: 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.

Date: 2020
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0242101

DOI: 10.1371/journal.pone.0242101

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