摘要
Dear Editor,We thank Agilli et al.and Kayadibi et al.for their interest in our manuscript[1].Taken together,their letters raise points of clarification regarding the utility and general applicability of the‘aspartate aminotransferase-to-platelet ratio index’(APRI)test in the evaluation of liver fibrosis.Our first comment is that their concern over confounders of the APRI unrelated to liver disease is valid.Indeed,confounders would diminish the ability of APRI to predict advanced liver fibrosis,leading to false negatives.Given that our results were significant,this insight strengthens our findings.Also,in defense of APRI,most other non-invasive predictors of liver fibrosis are vulnerable to confounding by extraneous conditions,which could instead lead to false positives.The‘hepascore’and‘fibrotest’,for example,utilizes bilirubin(confounded by Gilbert’s)and Gamma-Glutamyl Transferase(GGT)(confounded by cholestasis)[2].
