Help with APRI formula

[copyman]

just curious to what my APRI score would be and also another formula from an article from medscape that mikesimone posted. "AST levels (x ULN)/platelets counts (103/l) x 100"
not to good with math so i will post some of my stats from last blood test and maybe someone will figure it out for me. thanks in advance:

AST 33 (norm 0-40)
ALT 60 (norm 0-55)
Platelets 213
GGT (from 10/06 test)

[nygirl7]

Sorry copyman - after almost 2 years here I have no idea what that is or I'd give you some input.

[HCA]

If you want to know if you have cirrhosis use this link
http://www.haltctrial.org/
Just put in your numbers to the cirrhosis predictor and it does the calculation for you.
Your Alt Ast ratio is good because the Alt is higher than the Ast,also your platelets are normal so from the small amount of info you have given,you dont give the CGT although you mention it, there is nothing to suggest that you have strutursal changes to your liver.

[jmjm530]

This might help: http://www.haltctrial.org/
Your "GGT" is missing, but the other numbers are a lot better than mine were pre-treatment and I think I scored something like 20 per chance of cirrhosis based on this calculator. Of course, it is what it is and shouldn't be used in lieu of the other stuff including the opnion of a good clinician.

Hope this finds you well,

-- Jim

[mikesimon]

Your AST/Platelet ratio = .15 and if I am understanding the article a ratio >.7 suggests significant fibrosis(F2) with a sensitivity of 85% and a specificity of 66%. A ratio of >1.5 suggests cirrhosis with a sensitivity of 73% and a specificity of 81%. I think you're in good shape according to that indicator. Regarding the AST/ALT ratio: Your ratio is .55 and the ratio which the article uses to indicate fibrosis is >.8 and has a sensitivity of 52% and a specificity of 61%. The ratio the article uses to indicate cirrhosis is >1 and has a sensitivity of 36% and a specificity of 82%.
So according to this article you're in good shape. Remember I'm no doctor and I could be wrong about this but that's my take on it - for what it's worth.
Mike

[copyman]

thanks for the responses.
jmjm, my GGT was 31 from a sept fibrosure test, the other bloodwork was last week.
HCA, i am aware of the haltc calculator and mine came back somewhere btwn 10-15% probability of bx showing cirrhosis, i found this to be high for all my good tests.
mikesimone, like i said my math skills are horrible, not sure if i understand but you say my ast/plat ratio = .15 and >.7 is significant fibrosis, isn't .15 more then .7? and to make myself sound even more stupid, in regards to the AST/ALT ratio, isn't my ratio of .55 more then >.8 ?
i guess i will always doubt the condition of my liver because i did not have a bx. i did have a fibrosure test which came back as F0 and hope to have a scan with dr A in boston in the next few months.

[mikesimon]

No, all your ratios are below the values used in the article. You're good if I understand it right. Mike

[OceanLiver]

What is the definition of and difference between, sensitivity and specificity in these studies?  

[mikesimon]

To address your specific question: "isn't my ratio of .55 more then >.8 ? " No it is not - .55 is less than .8 which is less than .75 which is less than .9 which is less than 1.0. It's easy to get confused when you're trying to sort this stuff out. At the risk of painting too rosy a picture I don't see anything in your numbers that would suggest any problem with your liver architecture but I'm just another patient trying to find my way through this crazy disease. I wish you well and hope you can get some peace of mind. If you could see some of my past numbers you'd know where I am coming from with the "rosy picture". Mike

[copyman]

thanks for the clarification :-) wishing the best for you as well.

[mikesimon]

In my effort to make things crystal clear I screwed it up. I would guess you realized it but I want to clarify anyway.
I incorrectly said: [To address your specific question: "isn't my ratio of .55 more then >.8 ? " No it is not - .55 is less than .8 which is less than .75 which is less than .9 which is less than 1.0.]
Obviously .8 is not less than .75  - I meant to say that .75 was less than .8 etc.
Sorry about that copyman.
Mike

[mikesimon]

I stumbled upon this tread and realized that I had been mistaken. I applied the incorrect APRI formula. I want to correct my error for the sake of accuracy of information. I apologize for re-introducing an old thread but I hate inaccurate information. If I have made another error , please correct me.

The APRI is a formula which attempts to diagnose fibrosis/cirrhosis using simple lab results.


This is the correct formula I believe.

APRI = AST/Upper limit of AST
           ------------------------------------------   x 100
               Platelet count (10 to the ninth/L)

Copyman  AST 33 40  = .83   .
.83/213 (Platelet Count) X 100 =  .3873

Copyman's APRI was .3873 back then and not .15 as I said back then.

"Our primary outcome measure was APRI. The APRI is a non-invasive marker of liver fibrosis initially proposed and developed by Wai et al (23) for use in chronic HCV-infected individuals that has been validated in HIV/HCV coinfected patients (30,31). Using commonly available blood tests it provides a surrogate marker of fibrosis. Wai et al demonstrated that an APRI of > 1.5 predicted significant fibrosis (Ishak stage ≥ 3) with an area under receiving operator characteristic curve (AUC) of 0.80, and cirrhosis (Ishak score of 5 or 6) with an AUC of 0.89 (23). Other investigators have validated the use of APRI in chronic hepatitis C (32-35) either alone or in combination with other biomarkers. Shastry et al evaluated 50 HIV/HCV coinfected patients with liver biopsies and found that APRI was useful in excluding advanced liver fibrosis (31). There is some evidence to suggest that APRI may be of more limited value in liver fibrosis due to causes other than chronic HCV (36,37).
We identified laboratory results for AST and platelets, as well as HIV RNA, alanine aminotransferace (ALT), total bilirubin, and albumin at the time closest to the available survey date. These tests are generally performed at least every three months. For AST and platelets, we included test results within 30 days of survey administration. We calculated APRI using the standard formula:
equation M1

There were several different clinical laboratories that performed testing, and each lab determined their own upper limit of normal. We defined 40 U/L as the upper limit of normal for AST. We analyzed APRI as a categorical outcome (APRI1.5). We defined minimal liver disease as an APRI score 1.5. Intermediate scores were categorized as indeterminate for the purpose of this analysis."

See:  http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2654191

Mike

[Miss604]

Hi I haven't spoke to you or anyone for awhile ..I have been deeply depressed, I was a non-responder AGAIN the 2nd time around..I must tell you I do not know as much as mikesimon does, he is very knowledgeble, I only know your numbers are better than mine. My last test after 46 weeks of meds, Rib. and Peg. were RBC 3.20 HGB 10.3 HCT 29.5 and PLA.110 My TBIL was 1.3 SGOT 58 DBIL 0.5 I had a biopsy and my liver is shunken in some areas, and I have early Chirossis, and I have severe portal fibrosis and sigments of my liver show disruption of normal architecture...so as you see the Interferon did not work for me, I now have a appt to see another hep doctor in Linwood, big long name Pappadolpolis or somthing like that. I also am now getting pain in right area and legs are so painful I ride a scooter( medical one) for small errands.

[copyman]

Hi, Nice to hear from you. So sorry you are not feeling well. I hope things work out with the new doctor.  
I will send you a private message soon.