Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2022; 28(16): 1671-1680
Published online Apr 28, 2022. doi: 10.3748/wjg.v28.i16.1671
Aspartate transferase-to-platelet ratio index-plus: A new simplified model for predicting the risk of mortality among patients with COVID-19
Ali Madian, Ahmed Eliwa, Hytham Abdalla, Haitham A Azeem Aly
Ali Madian, Haitham A Azeem Aly, Department of Internal Medicine, Faculty of Medicine, Al-Azhar University-Assiut, Assiut 71524, Egypt
Ahmed Eliwa, Department of Internal Medicine, Faculty of Medicine, Al-Azhar University-Cairo, Cairo 11754, Egypt
Hytham Abdalla, Department of Chest Diseases, Faculty of Medicine, Al-Azhar University-Assiut, Assiut 71524, Egypt
Author contributions: Madian A was responsible for the study conception and design, the data acquisition, analysis and interpretation, the statistical analysis, and writing of the first draft of the manuscript; Eliwa A and Abdalla H contributed to the data collection; Azeem HA reviewed the manuscript and provided critical scientific input; all authors approved the final manuscript.
Institutional review board statement: The study was approved by the Ethics Committee of Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
Informed consent statement: No informed consent was required, as patient identity is not revealed in the retrospective analysis.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at a.madian@azhar.edu.eg.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ali Madian, MD, MSc, Lecturer, Department of Internal Medicine, Faculty of Medicine, Al-Azhar University-Assiut, Assiut 71524, Egypt. a.madian@azhar.edu.eg
Received: November 16, 2021
Peer-review started: November 16, 2021
First decision: January 11, 2022
Revised: January 21, 2022
Accepted: March 16, 2022
Article in press: March 16, 2022
Published online: April 28, 2022
Abstract
BACKGROUND

Coronavirus disease 2019 (COVID-19) has a spectrum of clinical syndromes with serious involvement of the lung and frequent effection of the liver and hemostatic system. Blood biomarkers are affordable, rapid, objective, and useful in the evaluation and prognostication of COVID-19 patients.

AIM

To investigate the association between aspartate transferase-to-platelet ratio index (APRI) and in-hospital mortality to develop a COVID-19 mortality prediction model.

METHODS

A multicenter cohort study with a retrospective design was conducted. Medical records of all consecutive adult patients admitted to Al-Azhar University Hospital (Assiut, Egypt) and Chest Hospital (Assiut, Egypt) with confirmed COVID-19 from July 1, 2020 to October 1, 2020, were retrieved and analyzed. The patient cohort was classified into the following two categories based on the APRI: (1) COVID-19 presenting with APRI ≤ 0.5; and (2) COVID-19 presenting with APRI (> 0.5 and ≤ 1.5). The association between APRI and all-cause in-hospital mortality was analyzed, and the new model was developed through logistic regression analyses.

RESULTS

Of the 353 patients who satisfied the inclusion criteria, 10% were admitted to the intensive care unit (n = 36) and 7% died during the hospital stay (n = 25). The median age was 40 years and 50.7% were male. On admission, 49% had aspartate transferase-dominant liver injury. On admission, APRI (> 0.5 and ≤ 1.5) was independently associated with all-cause in-hospital mortality in unadjusted regression analysis and after adjustment for age and sex; after stepwise adjustment for several clinically relevant confounders, APRI was still significantly associated with all-cause in-hospital mortality. On admission, APRI (> 0.5 and ≤ 1.5) increased the odds of mortality by five-times (P < 0.006). From these results, we developed a new predictive model, the APRI-plus, which includes the four predictors of age, aspartate transferase, platelets, and serum ferritin. Performance for mortality was very good, with an area under the receiver operating curve of 0.90.

CONCLUSION

APRI-plus is an accurate and simplified prediction model for mortality among patients with COVID-19 and is associated with in-hospital mortality, independent of other relevant predictors.

Keywords: COVID-19, Aspartate transferase-to-platelet ratio index, Aspartate transferase, All-cause in-hospital mortality, Serum ferritin, SARS-CoV-2

Core Tip: Aspartate transferase-to-platelet ratio index-plus can be used to predict the severity of coronavirus disease 2019. The performance of the model for mortality was very good, with an area under the receiver operating curve of 0.90. This new prediction model could help in estimating the risk of mortality and may, therefore, assist in triaging patients. Moreover, our study confirmed that an aspartate transferase-dominant pattern, diabetes mellites, leukocytosis, and increased ferritin levels are associated with fatal outcomes.