Concordancia entre el resultado de la biopsia hepática y el índice APRI (Ast to Platelet Ratio Index) en el diagnóstico de cirrosis en pacientes con enfermedad hepática autoinmune / Concordance between hepatic biopsy and the APRI index (Ast to Platelet Ratio Index) for the diagnosis of cirrhosis in patients with autoimmune liver disease

Introducción y objetivos: Se ha propuesto que métodos no invasivos pueden remplazar la biopsia hepática en el diagnóstico del daño tisular en pacientes con hepatopatía autoinmune (EHA). Este estudio evalúa el rendimiento diagnóstico y grado de concordancia entre el índice Ast to Platelet Ratio Index (APRI) y la biopsia hepática en el diagnóstico de cirrosis en estos pacientes. Material y métodos: En una cohorte de pacientes con EHA se determinó el valor del índice APRI y los resultados de la biopsia hepática según la escala METAVIR. Se evaluó el área bajo la curva (AUC) y la concordancia entre un valor de APRI > 2 y un puntaje METAVIR F4 como marcadores de la presencia de cirrosis hepática mediante un estadístico de kappa. Resultados: Se incluyeron 70 pacientes (51 ± 13 años). Las hepatopatías autoinmunes más frecuentes fueron la cirrosis biliar primaria (CBP) (40%), Hepatitis autoinmune (HAI) (24,3%) y el síndrome de sobreposición HAI–CBP (32,9%). Se confirmó cirrosis por biopsia en 16 pacientes (22,9%); 15 pacientes (21,4%) presentaron índice APRI > 2 (cirrosis) y solo seis cumplieron ambos criterios. El AUC del APRI fue de 0,77 (IC 95% 0,65-0,88). La concordancia entre las pruebas fue baja para un punto de corte APRI > 2 (kappa 0,213; IC 95% 0,094 - 0,332), o para puntos de corte > 1,5, > 1 o > 0,5 (kappa 0,213, 0,255, 0,257, respectivamente). Conclusiones: Nuestros resultados sugieren que existe un pobre acuerdo entre el resultado del APRI y la biopsia hepática en el diagnóstico de cirrosis en pacientes con EHA, por lo tanto, no se debe utilizar como método diagnóstico único para determinar la presencia de cirrosis.(AU)

Introduction and objectives: It has been proposed that non-invasive methods may replace liver biopsy for the diagnosis of tissue damage in patients with autoimmune liver disease (ALD). The aim of this study was to determine diagnostic performance and degree of concordance between the APRI index and liver biopsy for diagnosing cirrhosis in these patients. Material and methods: In a cohort of patients with ALD, the value of the APRI index and liver biopsy results were determined according to the METAVIR score. The AUC and the degree of concordance between an APRI value >2 and a METAVIR score of F4 were evaluated as markers of liver cirrhosis, through a kappa statistic. Results: In total, 70 patients (age 51 ± 13 years) were included. The most common autoimmune liver diseases were primary biliary cirrhosis (PBC) (40%), autoimmune hepatitis (AIH) (24.3%) and AIH-PBC overlap syndrome (32.9%). Cirrhosis was confirmed by biopsy in 16 patients (22.9%). 15 patients (21.4%) had an APRI index >2 (Cirrhosis) and only six met both criteria. The AUC of the APRI was 0.77 (95% CI 0.65-0.88). The degree of concordance between the tests was low for an APRI cut-off point >2 (kappa 0.213; 95% CI 0.094-0.332), as well as for cut-off points >1.5, >1 and >0.5 (kappa 0.213, 0.255, 0.257, respectively). Conclusion: Our results suggest that there is little concordance between APRI and liver biopsy for the diagnosis of cirrhosis in patients with ALD. It should therefore not be used as a single diagnostic method to determine cirrhosis.(AU)

Concordance between hepatic biopsy and the APRI index (Ast to Platelet Ratio Index) for the diagnosis of cirrhosis in patients with autoimmune liver disease. / Concordancia entre el resultado de la biopsia hepática y el índice APRI (Ast to Platelet Ratio Index) en el diagnóstico de cirrosis en pacientes con enfermedad hepática autoinmune.

INTRODUCTION AND OBJECTIVES: It has been proposed that non-invasive methods may replace liver biopsy for the diagnosis of tissue damage in patients with autoimmune liver disease (ALD). The aim of this study was to determine diagnostic performance and degree of concordance between the APRI index and liver biopsy for diagnosing cirrhosis in these patients. MATERIAL AND METHODS: In a cohort of patients with ALD, the value of the APRI index and liver biopsy results were determined according to the METAVIR score. The AUC and the degree of concordance between an APRI value >2 and a METAVIR score of F4 were evaluated as markers of liver cirrhosis, through a kappa statistic. RESULTS: In total, 70 patients (age 51 ± 13 years) were included. The most common autoimmune liver diseases were primary biliary cirrhosis (PBC) (40%), autoimmune hepatitis (AIH) (24.3%) and AIH-PBC overlap syndrome (32.9%). Cirrhosis was confirmed by biopsy in 16 patients (22.9%). 15 patients (21.4%) had an APRI index >2 (Cirrhosis) and only six met both criteria. The AUC of the APRI was 0.77 (95% CI 0.65-0.88). The degree of concordance between the tests was low for an APRI cut-off point >2 (kappa 0.213; 95% CI 0.094-0.332), as well as for cut-off points >1.5, >1 and >0.5 (kappa 0.213, 0.255, 0.257, respectively) CONCLUSION: Our results suggest that there is little concordance between APRI and liver biopsy for the diagnosis of cirrhosis in patients with ALD. It should therefore not be used as a single diagnostic method to determine cirrhosis.

Las preguntas más frecuentes en embarazo y hepatitis B / Most frequently asked questions about pregnancy and hepatitis B

Se continúa estimando que, en la actualidad, aproximadamente 350 millones de personas en el mundo están crónicamente infectadas con el virus de la hepatitis B, y que en las áreas endémicas como Asia, África subsahariana y Amazonas la infección se origina más frecuentemente durante el periodo perinatal o en la niñez temprana, lo cual se relaciona a su vez con la alta prevalencia del antígeno de la hepatitis B (AgeB) (40 a 50%) en las mujeres en edad reproductiva (1-4).

Currently there are an estimated 350 million people in the world who have chronic hepatitis B infections. In areas where the disease is endemic such as Asia, Sub-Saharan Africa and the Amazon region, the infection is most often acquired in the prenatal period or in early childhood. This is in turn related to the high prevalence of Hepatitis B e-Antigen (HBeAg) (40% to 50%) found among women of reproductive age (1-4).