Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2015; 21(19): 5893-5900
Published online May 21, 2015. doi: 10.3748/wjg.v21.i19.5893
Validation of aspartate aminotransferase to platelet ratio for diagnosis of liver fibrosis and prediction of postoperative prognosis in infants with biliary atresia
Li-Yuan Yang, Jie Fu, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Zheng-Rong Chen, Li-Juan He, Zhe Wen, Hui Wang, Le Li, Feng-Hua Wang, Jia-Kang Yu, Yi Xu, Si-Tang Gong, Hui-Min Xia, Hai-Ying Liu
Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children’s Medical Center, Guangzhou 510120, Guangdong Province, China
Jie Fu, Birth Cohort Study, Guangzhou Medical University Affiliated Guangzhou Women and Children’s Medical Center, Guangzhou 510623, Guangdong Province, China
Zheng-Rong Chen, Li-Juan He, Feng-Hua Wang, Department of Pathology, Guangzhou Medical University Affiliated Guangzhou Women and Children’s Medical Center, Guangzhou 510623, Guangdong Province, China
Zhe Wen, Hui Wang, Le Li, Jia-Kang Yu, Hui-Min Xia, Department of Neonatal Surgery, Guangzhou Medical University Affiliated Guangzhou Women and Children’s Medical Center, Guangzhou 510623, Guangdong Province, China
Yi Xu, Si-Tang Gong, Department of Infectious Diseases, Guangzhou Medical University Affiliated Guangzhou Women and Children’s Medical Center, Guangzhou 510120, Guangdong Province, China
Author contributions: Yang LY, Peng XF and Pang SY performed the majority of experiments; Chen ZR, He LJ and Wang FH reviewed the liver sections; Gao KK analyzed the data and was also involved in editing the manuscript; Wen Z, Wang H, Li L, Yu JK, Xu Y and Gong ST collected all the clinical information; Yang LY, Fu J, Xia HM and Liu HY designed the study and wrote the manuscript; Yang LY and Fu J contributed equally to this work.
Supported by grants from General Medical Project of Guangzhou Municipal Health Bureau, No. 20141A010025; Western Medicine Key Project of Guangzhou Municipal Health Bureau, No. 201102A212023.
Ethics approval: The study was reviewed and approved by Guangzhou Medical University Affiliated Guangzhou Women and Children’s Medical Center Institutional Review Board.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors declare that they have no competing interests.
Data sharing: Technical appendix, statistical code, and dataset are available from the corresponding author at xiangliuhaiying@aliyun.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hai-Ying Liu, PhD, MD, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children’s Medical Center, 318Renminzhong Road, Guangzhou 510120, Guangdong Province, China. xiangliuhaiying@aliyun.com
Telephone: +86-20-81330639 Fax: +86-20-81330639
Received: November 24, 2014
Peer-review started: November 25, 2014
First decision: December 11, 2014
Revised: January 12, 2015
Accepted: February 13, 2015
Article in press: February 13, 2015
Published online: May 21, 2015
Abstract

AIM: To validate the value of aspartate aminotransferase to platelet ratio index (APRI) in assessment of liver fibrosis and prediction of postoperative prognosis of biliary atresia (BA) infants from Mainland China.

METHODS: Medical records of 153 BA infants who were hospitalized from January 2010 to June 2013 were reviewed. The efficacy of APRI for diagnosis of liver fibrosis was assessed using the receiver operator characteristic (ROC) curve compared to the pathological Metavir fibrosis score of the liver wedge specimens of 91 BA infants. The prognostic value of preoperative APRI for jaundice persistence, liver injury, and occurrence of cholangitis within 6 mo after KP was studied based on the follow-up data of 48 BA infants.

RESULTS: APRI was significantly correlated with Metavir scores (rs = 0.433; P < 0.05). The mean APRI value was 0.76 in no/mild fibrosis group (Metavir score F0-F1), 1.29 in significant fibrosis group (F2-F3), and 2.51 in cirrhosis group (F4) (P < 0.001). The area under the ROC curve (AUC) of APRI for diagnosing significant fibrosis and cirrhosis was 0.75 (P < 0.001) and 0.81 (P = 0.001), respectively. The APRI cut-off of 0.95 was 60.6% sensitive and 76.0% specific for significant fibrosis diagnosis, and a threshold of 1.66 was 70.6% sensitive and 82.7% specific for cirrhosis. The preoperative APRI in infants who maintained jaundice around 6 mo after KP was higher than that in those who did not (1.86 ± 2.13 vs 0.87 ± 0.48, P < 0.05). The AUC of APRI for prediction of postoperative jaundice occurrence was 0.67. A cut-off value of 0.60 showed a sensitivity of 66.7% and a specificity of 83.3% for the prediction of jaundice persistence. Preoperative APRI had no significant association with later liver injury or occurrence of cholangitis.

CONCLUSION: Our study demonstrated that APRI could diagnose significant liver fibrosis, especially cirrhosis in BA infants, and the elevated preoperative APRI predicts jaundice persistence after KP.

Keywords: Aspartate aminotransferase to platelet ratio index, Biliary atresia, Cirrhosis, Liver fibrosis, Prognosis

Core tip: There is still controversy over the role of aspartate aminotransferase to platelet ratio index (APRI) in the diagnosis of liver fibrosis and prognosis in biliary atresia. In this paper, we confirmed that APRI could help diagnose significant liver fibrosis, especially cirrhosis in a cohort of infants with biliary atresia from Mainland China, and preoperative APRI also could predict jaundice persistence after Kasai portoenterostomy. These results may have implications in the management of this disease.