{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T01:58:11Z","timestamp":1792547891518,"version":"4.5.0"},"reference-count":64,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":1645,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2011,3]]},"abstract":"<jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>\n                      <jats:bold>The aspartate aminotransferase-to-platelet ratio index (APRI), a tool with limited expense and widespread availability, is a promising noninvasive alternative to liver biopsy for detecting hepatic fibrosis. The objective of this study was to update the 2007 meta-analysis to systematically assess the accuracy of APRI in predicting significant fibrosis, severe fibrosis, and cirrhosis stage in hepatitis C virus (HCV) monoinfected and HCV \/ human immunodeficiency virus (HIV) coinfected individuals. Studies comparing APRI versus biopsy in HCV patients were identified via a thorough literature search. Areas under summary receiver operating characteristic curves (AUROC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to examine the APRI accuracy for the diagnosis of significant fibrosis, severe fibrosis, and cirrhosis. Heterogeneity was explored using meta-regression. Twenty-one additional studies were eligible for the update and, in total, 40 studies were included in this review (n = 8,739). The summary AUROC of the APRI for the diagnosis of significant fibrosis, severe fibrosis, and cirrhosis were 0.77, 0.80, and 0.83, respectively. For significant fibrosis, an APRI threshold of 0.7 was 77% sensitive and 72% specific. For severe fibrosis, a threshold of 1.0 was 61% sensitive and 64% specific. For cirrhosis, a threshold of 1.0 was 76% sensitive and 72% specific. Moreover, we found that the APRI was less accurate for the identification of significant fibrosis, severe fibrosis, and cirrhosis in HIV\/HCV coinfected patients.<\/jats:bold>\n                      <jats:bold>Conclusion:<\/jats:bold>\n                      <jats:bold>Our large meta-analysis suggests that APRI can identify hepatitis C-related fibrosis with a moderate degree of accuracy. Application of this index may decrease the need for staging liver biopsy specimens among chronic hepatitis C patients. (Hepatology 2011)<\/jats:bold>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hep.24105","type":"journal-article","created":{"date-parts":[[2010,12,7]],"date-time":"2010-12-07T16:03:16Z","timestamp":1291737796000},"page":"726-736","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":905,"title":["Performance of the Aspartate Aminotransferase-to-Platelet Ratio Index for the Staging of Hepatitis C-Related Fibrosis: An Updated Meta-Analysis \u00a7\u0394"],"prefix":"10.1097","volume":"53","author":[{"given":"Zhong-Hua","family":"Lin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Ning","family":"Xin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quan-Jiang","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang-Jun","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Hui","family":"Zhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi-Ying","family":"Xuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-3-20250207","doi-asserted-by":"crossref","first-page":"4152","DOI":"10.1056\/NEJM200107053450107","article-title":"Hepatitis C virus infection.","volume":"345","author":"Lauer","year":"2001","journal-title":"N Engl J Med"},{"key":"R2-3-20250207","doi-asserted-by":"crossref","first-page":"227242","DOI":"10.1053\/jhep.2002.34734","article-title":"Burden of liver disease in the United States: summary of a workshop.","volume":"36","author":"Kim","year":"2002","journal-title":"HEPATOLOGY"},{"issue":"Suppl","key":"R3-3-20250207","first-page":"S3S20","article-title":"National Institutes of Health Consensus Development Conference Statement: management of hepatitis C: 2002June 1012, 2002.","volume":"36","year":"2002","journal-title":"HEPATOLOGY"},{"key":"R4-3-20250207","doi-asserted-by":"crossref","first-page":"744749","DOI":"10.1136\/gut.2003.020263","article-title":"Natural history of compensated viral cirrhosis: a prospective study on the incidence and hierarchy of major complications.","volume":"53","author":"Benvegnu","year":"2004","journal-title":"Gut"},{"issue":"Suppl","key":"R5-3-20250207","first-page":"i1i21","article-title":"Clinical guidelines on the management of hepatitis C.","volume":"49","author":"Booth","year":"2001","journal-title":"Gut"},{"key":"R6-3-20250207","doi-asserted-by":"crossref","first-page":"495500","DOI":"10.1056\/NEJM200102153440706","article-title":"Liver biopsy.","volume":"344","author":"Bravo","year":"2001","journal-title":"N Engl J Med"},{"key":"R7-3-20250207","first-page":"14491457","article-title":"Sampling variability of liver fibrosis in chronic hepatitis C.","volume":"38","author":"Bedossa","year":"2003","journal-title":"HEPATOLOGY"},{"key":"R8-3-20250207","doi-asserted-by":"crossref","first-page":"518526","DOI":"10.1053\/jhep.2003.50346","article-title":"A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C.","volume":"38","author":"Wai","year":"2003","journal-title":"HEPATOLOGY"},{"key":"R9-3-20250207","doi-asserted-by":"crossref","first-page":"912921","DOI":"10.1002\/hep.21835","article-title":"Diagnostic accuracy of the aspartate aminotransferasetoplatelet ratio index for the prediction of hepatitis Crelated fibrosis: a systematic review.","volume":"46","author":"Shaheen","year":"2007","journal-title":"HEPATOLOGY"},{"key":"R10-3-20250207","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1471-2288-2-9","article-title":"Conducting systematic reviews of diagnostic studies: didactic guidelines.","volume":"2","author":"Deville","year":"2002","journal-title":"BMC Med Res Methodol"},{"key":"R11-3-20250207","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/1471-2288-3-25","article-title":"The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews.","volume":"3","author":"Whiting","year":"2003","journal-title":"BMC Med Res Methodol"},{"key":"R12-3-20250207","first-page":"1520","article-title":"The French METAVIR Cooperative Study Group.","volume":"20","year":"1994","journal-title":"HEPATOLOGY"},{"key":"R13-3-20250207","doi-asserted-by":"crossref","first-page":"14091417","DOI":"10.1097\/00000478-199512000-00007","article-title":"Chronic hepatitis. 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