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Diagnostic accuracy of the gamma-glutamyl transpeptidase to platelet ratio (GPR) using transient elastography as a reference
  1. Maud Lemoine1,2,
  2. Mark Thursz1,
  3. Vincent Mallet3,
  4. Yusuke Shimakawa2,4
  1. 1Department of Hepatology, Imperial College London, St Mary's Hospital, London, UK
  2. 2Medical Research Council Laboratories, The Gambia, West Africa
  3. 3Department of Hepatology, Hôpital Cochin, AP-HP, Paris, France
  4. 4Institut Pasteur, Unité d’Épidémiologie des Maladies Émergentes, Paris, France
  1. Correspondence to Dr Maud Lemoine, Imperial College London, South Wharf Street, London W21NY, UK; m.lemoine{at}

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We read with great interest the letter from Stockdale et al1 in which they concluded that the gamma-glutamyl transpeptidase to platelet ratio (GPR) and aspartate transaminase (AST)-to-platelet ratio index (APRI) would not be ideal for the diagnosis of liver fibrosis in patients with HIV–HBV coinfection from West Africa. In a relatively small cohort of HIV–HBV coinfected subjects (n=100) from Ghana, the authors reported poor sensitivity (57%–67%) and specificity (63%–79%) of GRP and APRI in diagnosing advanced fibrosis (≥F3) and cirrhosis (F4). These findings are interesting, but should be interpreted with caution with regards to the internal validity of using transient elastography as the reference, the study population itself and the cut-offs generated as a result.

The GPR was originally developed for the assessment of liver fibrosis in HBV mono-infected individuals in a West African setting.2 It has been recently applied to patients predominately treated for HIV–HBV coinfection by a French team, reporting good diagnostic performance to diagnose cirrhosis (sensitivity 77%, specificity 87%).3 In both studies, the accuracy of GPR was assessed …

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  • Response to ‘The Gamma-glutamyl transpeptidase to Platelet Ratio (GPR) shows poor correlation with transient elastography measurements of liver fibrosis in HIV-positive patients with chronic hepatitis B in West Africa’ by Stockdale et al.

  • Contributors ML drafted the paper. YS was in charge of the statistical analysis. VM, ML and YS developed the GPR. MT is the chief investigator of the PROLIFICA programme where the patients are derived from. All the authors read and approved the content of this letter.

  • Competing interests None declared.

  • Ethics approval Guide on Approval Procedures Introduction Research projects that involve participation of human participants or use of data or samples obtained from humans must have approval by an ethics committee before their commencement. This is in keeping with International Ethical Standards. The Gambia Government/MRC Joint Ethics Committee (EC).

  • Provenance and peer review Not commissioned; internally peer reviewed.