Non-invasive fibrosis algorithms are clinically useful for excluding cirrhosis in prisoners living with hepatitis C Academic Article uri icon


  • Background and aims Prison-based HCV treatment rates remain low due to multiple barriers, including accessing transient elastography for cirrhosis determination. The AST-to-platelet ratio index (APRI) and FIB-4 scores have excellent negative predictive value (NPV) in hospital cohorts to exclude cirrhosis. We investigated their performance in a large cohort of prisoners with HCV infection. Methods This was a retrospective cohort study of participants assessed by a prison-based hepatitis program. The sensitivity, specificity, NPV and positive predictive value (PPV) of APRI and FIB-4 for cirrhosis were then analysed, with transient elastography as the reference standard. The utility of age thresholds as a trigger for transient elastography was also explored. Results Data from 1007 prisoners were included. The median age was 41, 89% were male, and 12% had cirrhosis. An APRI cut-off of 1.0 and FIB-4 cut-off of 1.45 had NPVs for cirrhosis of 96.1% and 96.6%, respectively, and if used to triage prisoners for transient elastography, could reduce the need for this investigation by 71%. The PPVs of APRI and FIB-4 for cirrhosis at these cut-offs were low. Age ≤35 years alone had a NPV for cirrhosis of 96.5%. In those >35 years, the APRI cut-off of 1.0 alone had a high NPV >95%. Conclusion APRI and FIB-4 scores can reliably exclude cirrhosis in prisoners and reduce requirement for transient elastography. This finding will simplify the cascade of care for prisoners living with hepatitis C.


  • Papaluca, T
  • Craigie, A
  • McDonald, L
  • Edwards, A
  • MacIsaac, M
  • Holmes, JA
  • Jarman, M
  • Lee, T
  • Huang, H
  • Chan, A
  • Lai, M
  • Sundararajan, Vijaya
  • Doyle, JS
  • Hellard, M
  • Stoove, M
  • Howell, J
  • Desmond, P
  • Iser, D
  • Thompson, AJ

publication date

  • November 18, 2020