Assessment of liver fibrosis progression in patients with chronic hepatitis C and normal alanine aminotransferase values: The role of AST to the platelet ratio index

Objectives To verify the value of indirect serum markers in the non-invasive assessment of liver fibrosis in patients with persistently normal or near normal alanine aminotransferases levels (NALT). Design and methods Forty HCV RNA positive, untreated patients with NALT (30 non-drinkers) underwent two liver biopsies, with a median interval of 78.5 months. The AST/ALT ratio, age–platelet index, AST to platelet ratio index (APRI), Forns fibrosis index and Bonaciniʹs discriminant score were simultaneously determined. Results In 19 patients, worsening of fibrosis was observed at the second biopsy in comparison to the index biopsy. Among non-drinkers, an APRI >0.4 had a 100% sensitivity in identifying subjects with significant liver fibrosis (Ishak staging score >2) and an APRI ≤0.4 had a 100% negative predictive value in excluding significant liver fibrosis. Conclusions APRI performs better, in comparison to all other markers, in correctly classifying patients with NALT with no progression to significant liver fibrosis.