462. Acute Changes in APRI and FIB-4 Scores During HCV Treatment
Session: Poster Abstract Session: Hepatitis C
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Poster_IDSA_FIB4APRI_vf.pdf (1.1 MB)
  • Background: AST to Platelet Ratio Index (APRI) and Fibrosis 4 score (FIB-4) are non-invasive measures of liver fibrosis in chronic hepatitis C (HCV). The aim of this study was to examine changes in APRI and FIB-4 scores in HCV-infected patients during direct acting antiviral (DAA) therapy.

    Methods: We evaluated 96 HCV-infected patients who achieved sustained virologic response (SVR) at 12 weeks post-treatment. Serum levels of AST, ALT, platelets, and albumin were obtained at baseline (n=93), week 4 (n=86), end of treatment (n=83), SVR (n=49), 6-months post-SVR (n=44) and 1-year post-SVR (n=22).

    Results: Between baseline and week 4, AST decreased 2.3-fold and ALT decreased 3.1-fold (Table 1, p<0.001 for both comparisons). AST and ALT levels did not change significantly beyond week 4 of treatment. Platelet counts increased 1.2-fold in the first 4 weeks of treatment but this increase appeared temporary as platelet counts returned to baseline 6 months post-SVR (142 x103/µL [IQR 76-310 x103/µL]). FIB-4 and APRI both significantly decreased between baseline and week 4 (Table 1, p<0.001 for both comparisons), but remained stable after week 4. Changes in FIB-4 and APRI were greater in those with cirrhosis compared to those without cirrhosis (FIB4: 0.64-fold decrease [IQR 0.50-0.88] in cirrhotics vs. 0.79-fold [IQR 0.63-0.94] in non-cirrhotics, p=0.07; APRI: 0.39-fold decrease [IQR 0.25-0.57] in cirrhotics vs. 0.47-fold [IQR 0.40-0.74] in non-cirrhotics, p=0.05). Albumin levels increased gradually from 3.9 g/dL [IQR 3.6-4.2 g/dL] to 4.1 g/dL [IQR 3.7-4.4 g/dL] at SVR (p=0.005) and subsequently remained stable.

    Baseline

    Week 4

    p-value

    AST (IU/L)

    61 (37-105)

    26 (IQR 22-35)

    p<0.001

    ALT (IU/L)

    61 (IQR 33-106)

    20 (IQR 15-31)

    p<0.001

    Platelet count (x103/µL)

    144 (IQR 98-202)

    167 (IQR 95-233)

    p<0.001

    APRI

    1.28 (IQR 0.66-2.99)

    0.49 (IQR 0.31-0.93)

    p<0.001

    FIB-4

    3.37 (IQR 1.77-6.63)

    1.29 (IQR 1.29-3.95)

    p<0.001

    Conclusion: Non-invasive markers of fibrosis, FIB4 and APRI, must be interpreted with caution during HCV therapy. APRI and FIB-4 decrease early in therapy, likely reflecting acute changes in liver inflammation rather than changes in fibrosis. Conversely, albumin, a marker of liver synthetic function, increases after treatment, suggesting gradual recovery of function after SVR. Long-term data is needed to determine clinical correlations of these biochemical changes.

    Christina Yek, MD, Carolina De La Flor, MD, Amit Singal, MD, Beverley Adams-Huet, MS and Mamta Jain, MD, University of Texas Southwestern, Dallas, TX

    Disclosures:

    C. Yek, None

    C. De La Flor, None

    A. Singal, Gilead: Grant Investigator , Grant recipient

    B. Adams-Huet, None

    M. Jain, Gilead Sciences: Grant Investigator and Investigator , Research grant
    AbbVie: Investigator , Research grant
    Merck: Grant Investigator , Research grant
    Bristol Myers Squibb: Investigator , Research grant
    Janssen: Investigator , Research grant

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