Noninvasive indices for monitoring disease course in Chinese patients with autoimmune hepatitis

Objective: Noninvasive and simple tests to forecast cirrhosis is in great need clinically. This study aimed to assess the clinical significance of several noninvasive indices in predicting cirrhosis in Chinese patients with autoimmune hepatitis (AIH). Materials and Methods: Liver function test and blood cell analysis were conducted in 76 AIH patients and 75 paired healthy subjects to calculate aspartate aminotransferase to alanine aminotransferase ratio(AAR), aspartate aminotransferase to platelet ratio index (APRI), fibrosis index based on the four factors (FIB-4), gamma-glutamyl transferase to platelet ratio (GPR), red blood cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and platelet to lymphocyte ratio (PLR). Binary logistic regression was performed to analysis the risk factors of liver cirrhosis and receiver operating characteristic (ROC) curve was conducted to evaluate the diagnostic value of each index and compare their diagnostic performance with serum biomarkers commonly used in the clinical setting for liver fibrosis assessing including hyaluronic acid (HA), laminin(LN), procollagen III N terminal peptide (PIIINP) and type IV collagen (ColIV). Results: AAR, APRI, FIB-4, GPR, NLR and RDW were elevated remarkably in AIH patients with cirrhosis; AAR, FIB-4 and RDW were identified to be independent risk factors of cirrhosis with OR (95%CI) of 3.517 (1.300-9.514), 1.247(1.032-1.506) and 1.414 (1.086-1.842) respectively; ROC analysis showed that the area under the ROC curve (AUC) of AAR, FIB-4 and RDW were 0.801,0.82 and 0.739, with moderate diagnostic value and better than HA, LN, PIIINP and ColIV in identifying those with cirrhosis from AIH patients. Conclusion: AAR, FIB-4 and RDW were independent risk factors of AIH cirrhosis and can be served as reference indices to monitor disease course in AIH.