Value of aspartate aminotransferase-to-platelet ratio index in judging the indication for antiviral therapy in patients with chronic HBV infection and alanine aminotransferase less than two times of upper limit of normal

Objective To investigate the value of aspartate aminotransferase-to-platelet ratio index ( APRI) in judging the indication for antiviral therapy [liver inflammation grade ( G) ≥2 or fibrosis stage ( S) ≥2] in patients with chronic HBV infection and alanine aminotransferase ( ALT) < 2 × upper limit of normal ( ULN) . Methods A retrospective analysis was performed for the clinical data of 207 patients with chronic HBV infection and ALT < 2 × ULN who were admitted to Nanyang Central Hospital from January 2015 to June 2017, and according to liver inflammation grade and fibrosis stage, these patients were divided into G < 2 + S < 2 group with 87 patients and G≥2 or S≥2 group with 120 patients. The results of liver biopsy and laboratory examination were recorded, and APRI was calculated. The Spearman correlation analysis was performed to investigate the correlation of APRI with liver inflammation grade and fibrosis stage. The area under the receiver operating characteristic curve ( AUC) was used to investigate the value of ALT, aspartate aminotransferase ( AST) , platelet count ( PLT) , and APRI in judging the indication for antiviral therapy in patients with ALT < 2 × ULN. The t-test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Results APRI was positively correlated with liver inflammation grade and fibrosis stage ( r = 0. 661 and 0. 597, P<0. 001) . Among ALT, AST, PLT, and APRI, APRI had the highest value in judging the indication for antiviral therapy, with AUCs of0. 913 in the G≥2 or S≥2 group, 0. 882 in the G≥2 group, and 0. 881 in the S≥2 group. APRI had an AUC of 0. 913 ( 95% confidence interval: 0. 871-0. 954) in predicting the indication in the G≥2 or S≥2 group at the optimal cut-off value of 0. 5324; when APRI was ≥0. 5324, the patients had marked liver histological changes, i. e., G≥2 or S≥2, which met the indication for antiviral therapy. APRI had a sensitivity of 87. 50%, a specificity of 89. 66%, a positive predictive value of 92. 11%, and a negative predictive value of 83. 87%. Conclusion For patients with chronic HBV infection and ALT < 2 × ULN, APRI has a good value in evaluating liver pathological changes and judging the timing of antiviral therapy and can reduce the frequency of invasive assessment of histological changes via liver biopsy.