N Khokhar1. 1. Division of gastroenterology, Department of Medicine, Shifa International Hospital and Shifa College of Medicine, Islamabad.
Abstract
OBJECTIVE: To assess the ratio of aminotransferases in combination with platelets count as a predictive factor for stages of fibrosis in patients with chronic hepatitis C virus infection. METHODS: A total of 266 patients were evaluated retrospectively who had undergone liver biopsy as a part of their evaluation for the management of chronic hepatitis C infection at Shifa International Hospital from 1998 to 2002. All these patients had complete blood counts and liver function tests including transaminases. The ratio of AST/ALT and platelet count of <150,000 were noted and degree of the fibrosis and cirrhosis on liver biopsies were matched. None of these patients had history of alcohol consumption. The fibrosis stages used were according to METAVIR score. RESULTS: An AST/ALT ratio of >1 and a platelet count of <150,000 had sensitivity of 85.6 and specificity of 90.0 with positive predictive value of 91.2 and negative predictive value of 83.4 for the fibrosis grade-III and IV. An AST/ALT ratio of <1 and a platelet count of >150,000 for grades 0-2, the sensitivity was 87.3, specificity 60.0, PPV 87.3 and NPV 48.0. CONCLUSION: An AST/ALT ratio of >1 in combination with a platelet count of <150,000 can predict advance stage of fibrosis and cirrhosis in patients with chronic hepatitis C infection. In these patients, a liver biopsy may not be necessary.
OBJECTIVE: To assess the ratio of aminotransferases in combination with platelets count as a predictive factor for stages of fibrosis in patients with chronic hepatitis C virus infection. METHODS: A total of 266 patients were evaluated retrospectively who had undergone liver biopsy as a part of their evaluation for the management of chronic hepatitis C infection at Shifa International Hospital from 1998 to 2002. All these patients had complete blood counts and liver function tests including transaminases. The ratio of AST/ALT and platelet count of <150,000 were noted and degree of the fibrosis and cirrhosis on liver biopsies were matched. None of these patients had history of alcohol consumption. The fibrosis stages used were according to METAVIR score. RESULTS: An AST/ALT ratio of >1 and a platelet count of <150,000 had sensitivity of 85.6 and specificity of 90.0 with positive predictive value of 91.2 and negative predictive value of 83.4 for the fibrosis grade-III and IV. An AST/ALT ratio of <1 and a platelet count of >150,000 for grades 0-2, the sensitivity was 87.3, specificity 60.0, PPV 87.3 and NPV 48.0. CONCLUSION: An AST/ALT ratio of >1 in combination with a platelet count of <150,000 can predict advance stage of fibrosis and cirrhosis in patients with chronic hepatitis C infection. In these patients, a liver biopsy may not be necessary.