Value Of Noninvasive Serological Models For Diagnosis Of Liver Fibrosis In Autoimmune Hepatitis

Background and Objective Autoimmune hepatitis(AIH)is a chronic liver disease mediated by autoimmune hepatic inflammation.Chronic inflammation and repeated damage to the liver can lead to fibrosis,cirrhosis,liver failure and even the death.Immunosuppressive therapy is considered to be the standard treatment regimen of AIH,which has been proved to be able to reverse or prevent the progression of fibrosis.Thus,it is crucial to monitor the fibrosis progression during AIH treatment.Liver biopsy remains the‘gold standard'for detection of liver fibrosis.However,it is also invasive,costly and limited by contraindications and complications.Hence,researchers have focused on noninvasive serological models of liver fibrosis in the past decade,but the diagnostic values in AIH are hardly studied.According to the analysis of routinely serological parameters,our study try to investigate the fibrosis biomarkers in AIH and compare the values of seven noninvasive models including fibrosis index based on the 4factors(FIB-4),aspartate aminotransferase-to-platelet ratio index(APRI),red blood cell volume distribution width-platelet ratio(RPR),globulin-platelet index(GPI),gamma-glutamyltransferase-to-platelet ratio(GPR),aspartate aminotransferase-to-alani-ne aminotransferase ratio(AAR)and lymphocyte-to-platelet ratio(LPR)in predicting liver fibrosis in(AIH),aiming to monitor the progress of the disease and lessen the need for liver biopsy.Materials and Methods 47 AIH patients who were hospitalized and underwent liver biopsy in First Affiliated Hospital of Anhui Medical University from November 2011 to May 2019 were enrolled,with 47 paired healthy subjects as a control.Blood routine examination and liver function test were collected to calculate FIB-4,APRI,GPI,GPR,AAR and LPR.RPR was calculated as red blood cell distribution width-coefficient of variation-to-platelet(RDW-CV/PLT)and red blood cell distribution width-standard deviation-to-platelet(RDW-SD/PLT).Student t-test or Mann-Whitney U-test was used to compare variables between two groups,and Kruskal-Wallis H test was used to compare variables in multiple groups.The correlations between variables and fibrosis stages were analyzed by Spearman correlation analysis.Area under receiver operating characteristic curve(AUROC)was used to compare the diagnostic values.Results Compared with healthy controls,AIH patients seemed to have lower levels of PLT and higher levels of RDW-CV,RDW-SD,globulin(GLO),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and gamma-glutamyl-transferase(GGT),which were statistically significant(P<0.05).Besides,There were statistical significance found between fibrosis stages for PLT,RDW-SD,mean corpuscular volume(MCV)and GGT.Moreover,PLT,MCV and GGT were correlated with fibrosis stages with the coefficients of-0.555,0.309 and-0.358(P<0.05),respectively.Except for APRI and GPR,FIB-4,RDW-CV/PLT,RDW-SD/PLT,GPI,AAR and LPR were also correlated with fibrosis stages(r_s=0.529,0.571,0.582,0.650,0.424,0.412,P<0.05).Among all models,GPI had the highest value for diagnosis of significant fibrosis(?S2)and advanced fibrosis(?S3)in AIH with AUROC of 0.810,0.871,sensitivity of 83.9%,100%,specificity of 81.2%,61.8%,positive predictive value of 89.7%,50.0%,and negative predictive value of 72.2%,100%,respectively.RDW-CV/PLT was almost identical to RDW-SD/PLT in predicting significant fibrosis(?S2)(AUROC=0.766,0.780)and advanced fibrosis(?S3)(AUROC=0.821,0.817).By contrast,FIB-4,AAR and LPR had low diagnostic values in predicting significant fibrosis(?S2)(AUROC=0.774,0.719,0.700)and advanced fibrosis(?S3)(AUROC=0.765,0.721,0.749).There was no significance for APRI and GPR in predicting significant fibrosis(?S2)and advanced fibrosis(?S3)in AIH(P>0.05).Conclusions 1.Among all models,GPI had the highest predictive value for significant fibrosis and advanced fibrosis in AIH,which would be a simple marker to discriminate patients with mild fibrosis(S1)from patients with significant fibrosis(?S2),contributed to the decrease of the need for liver biopsy in some patients.2.RDW-CV/PLT and RDW-SD/PLT had moderate diagnostic values in predicting significant fibrosis and advanced fibrosis in AIH,superior to FIB-4,AAR and LPR.3.There was no significance for APRI and GPR in predicting significant fibrosis and advanced fibrosis in AIH.