Value of fibrosis-4,aspartate aminotransferase-to-platelet ratio index,and globulin-platelet index in the diagnosis of significant liver fibrosis in autoimmune hepatitis

Objective To investigate the value of fibrosis-4( FIB-4),aspartate aminotransferase-to-platelet ratio index( APRI),and globulin-platelet index( GPI) in the diagnosis of significant liver fibrosis in autoimmune hepatitis( AIH). Methods A total of 47 AIH patients who were hospitalized and underwent liver biopsy in The First Affiliated Hospital of Anhui Medical University from November 2011 to May 2019 were enrolled as AIH group,and 47 healthy individuals,matched for age and sex,were enrolled as control group. According to the pathological results,AIH patients were divided into mild liver fibrosis( S1) group with 16 patients and significant liver fibrosis( S2-S4) group with 31 patients. The two groups were compared in terms of age,routine blood test results,and biochemical indices,and FIB-4,APRI,and GPI were calculated and compared between the two groups. The independent samples t-test was used for comparison of normally distributed continuous data between the two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between the two groups. A univariate binary logistic regression analysis was used to investigate the risk factors for significant liver fibrosis,and the area under the receiver operating characteristic curve( AUC) was used to compare the diagnostic value of each model. Results Compared with the control group,the AIH group had significant increases in globulin,alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,gamma-glutamyl transpeptidase( GGT),FIB-4,APRI,and GPI and significant reductions in platelet count( PLT) and albumin( all P < 0. 05). Compared with the mild liver fibrosis group,the significant liver fibrosis group had significant increases in age( t =-2. 681,P = 0. 010),FIB-4( Z =-3. 053,P = 0. 002),and GPI( Z =-3. 457,P = 0. 001) and significant reductions in PLT( t = 3. 185,P = 0. 003) and GGT( Z =-2. 290,P = 0. 022). The univariate analysis showed that age( odds ratio[OR]= 1. 074,95% confidence interval [CI]: 1. 013-1. 139,P = 0. 017),PLT( OR = 0. 987,95% CI: 0. 978-0. 997,P = 0. 010),FIB-4( OR = 1. 339,95% CI: 1. 046-1. 713,P = 0. 021),and GPI( OR = 4. 449,95% CI: 1. 319-15. 008,P = 0. 016) were influencing factors for significant liver fibrosis in AIH patients. FIB-4 and PLT had an AUC of 0. 774 and 0. 746,respectively,in the diagnosis of significant liver fibrosis in AIH patients,and GPI had an AUC of 0. 810,a sensitivity of 83. 9%,a specificity of 81. 2%,a positive predictive value of 89. 7%,and a negative predictive value of 72. 2% in the diagnosis of significant liver fibrosis and was superior to FIB-4 and PLT. APRI had no value in the diagnosis of significant liver fibrosis in AIH patients( P = 0. 271). Conclusion GPI has a certain value in predicting significant liver fibrosis in AIH patients and thus helps to reduce the need for liver biopsy in some patients.