A novel predictor of severe dengue: The aspartate aminotransferase/platelet count ratio index (APRI)

Zhang, Hao; Xie, Zhiwei; Xushuo, Xie; Ou, Yingyan; Zeng, Wenting; Zhou, Yuanping

doi:10.1002/jmv.25021

Cited by 21 publications

(34 citation statements)

References 26 publications

(30 reference statements)

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“…These results are more comparable to ours. Another study in China suggests that the ratio between AST/platelet count to be a useful predictor of severe dengue, though this study also was retrospective in nature and data collection was not restricted to early phase of the illness [28]. To have any significant effect on patient management (as prediction of plasma leakage is the goal), it is better to assess early clinical features or laboratory investigations rather than those recorded throughout the entire illness.…”

Section: Discussionmentioning

confidence: 99%

Risk prediction for severe disease and better diagnostic accuracy in early dengue infection; the Colombo dengue study

et al. 2019

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Background A major challenge in dengue management in resource limited settings is the confirmation of diagnosis. Clinical features of dengue often overlap with other infections and molecular diagnostic tools are not readily accessible to clinicians at hospitals. In addition, the prediction of plasma leakage in dengue is also difficult. Hematocrit level and ultrasound scans (combined with clinical parameters) are helpful to detect plasma leakage once it has happened, not before. Methods Colombo Dengue Study (CDS) is a prospective cohort study of clinically suspected adult dengue patients recruited from the National hospital of Sri Lanka (within the first 3 days of fever) that aimed to a) identify clinical and basic laboratory test parameters to differentiate dengue from non-dengue fever, b) evaluate the comparative efficacy of loop-mediated isothermal amplification (LAMP) for dengue diagnosis (vs. NS1 antigen test and RT-qPCR) and c) identify early associations that are predictive of plasma leakage or severe dengue. The basic laboratory tests considered here included hematological parameters, serum biochemistry and inflammatory markers. Results Only 70% of clinically suspected patients were confirmed as having dengue by either the NS1 antigen test or RT-qPCR. On a Bayesian latent class model which assumes no “gold standard”, LAMP performed equally or better than RT-qPCR and NS1 antigen test respectively. When confirmed dengue patients were compared with others, the earlier group had significantly lower lymphocyte counts and higher aspartate aminotransferase levels (AST) within the first 3 days of fever. Confirmed dengue patients with plasma leakage had a lower mean age and a higher median baseline AST level compared to those without plasma leakage ( p < 0.05). Conclusion Clinical suspicion overestimates the true number of dengue patients. RT-LAMP is a potentially useful low-cost diagnostic tool for dengue diagnosis. Confirmed dengue patients had significantly higher AST levels and lower lymphocyte counts in early disease compared to others. In confirmed dengue patients, younger age and a higher AST level in early infection were associated with subsequent plasma leakage. Electronic supplementary material The online version of this article (10.1186/s12879-019-4304-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Risk prediction for severe disease and better diagnostic accuracy in early dengue infection; the Colombo dengue study

et al. 2019

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“…Hepatic dysfunction and abnormal coagulation are common during the acute stage of dengue infection. About 61%–96% of dengue patients have elevated liver enzyme levels of aspartate aminotransferase (AST) and alanine transaminase (ALT), which peak at around day 7 of the onset of the illness [5, 6], while 7%–42.3% have prolonged activated partial thromboplastin time (aPTT) [5, 7] and 85.8%–98% have thrombocytopenia [8, 9]. Elevated liver transaminases [6, 9–12], prolonged aPTT [9, 12–14] and lower platelet count [4, 8, 9, 12, 13, 15] are more prominent in patients with severe dengue or poor outcomes.…”

Section: Introductionmentioning

confidence: 99%

Trajectories of hepatic and coagulation dysfunctions related to a rapidly fatal outcome among hospitalized patients with dengue fever in Tainan, 2015

Yeh

Liang

et al. 2019

PLoS Negl Trop Dis

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BackgroundHepatic dysfunction and coagulopathy are common in acute dengue illness. We analyzed the trajectories of the above parameters in the survivors and fatal patients in the outbreak in Tainan, 2015.MethodsA retrospective study was conducted using data from a tertiary hospital between January and December 2015. Multilevel modeling (MLM) was used to identify the changes in aminotransferase (AST), alanine aminotransferase (ALT), activated partial thromboplastin time (aPTT), and platelet counts from Day 0 to Day 7 of the onset of dengue infection. The machine-learning algorithm was used by purity measure assumption to calculate the accuracy of serum transaminases and coagulation variables to discriminate between the fatal and survival groups.ResultsThere were 4,069 dengue patients, of which 0.9% died in one week after illness onset (i.e., early mortality). Case fatality rate was the highest for those aged ≥70 years. Both AST and ALT values of the fatal group were significantly higher than those of the survivor group from Day 3 (AST median, 624 U/L vs. 60 U/L, p < 0.001; ALT median, 116 U/L vs. 29 U/L, p = 0.01) of illness onset and peaked on Day 6 (AST median, 9805 U/L vs. 90 U/L, p < 0.001; ALT median, 1504 U/L vs. 49 U/L, p < 0.001). AST ≥ 203 U/L, ALT ≥ 55 U/L, AST2/ALT criteria ≥337.35, or AST/platelet count ratio index (APRI) ≥ 19.18 on Day 3 of dengue infection had a high true positive rate, 90%, 78%, 100%, or 100%, respectively, of early mortality. The platelet counts of the fatal group declined significantly than those of the survivor group since Day 3 of illness onset (median, 19 x103/μl vs. 91 x103/μl, p < 0.01), and aPTT values of the fatal group significantly prolonged longer since Day 5 (median, 68.7 seconds vs. 40.1 seconds, p < 0.001).ConclusionsAST, ALT, and platelet counts should be monitored closely from Day 0 to Day 3 of dengue infection, and aPTT be followed up on Day 5 of infection to identify the individuals at risk for early mortality.

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“…One of these biomarkers, the APRI, has been widely studied as a minimally invasive marker of fibrosis and inflammation in hepatic disease [49, 50]. The APRI has also proven useful in predicting the severity of acute and systemic diseases such as dengue [19] and HELLP syndrome [51]. For this reason, we hypothesized that the APRI is altered in the acute phase of malaria since the liver is also targeted by Plasmodium [23].…”

Section: Discussionmentioning

confidence: 99%

“…There is strong evidence of the clinical value of the APRI in predicting liver inflammation of various etiologies [56]. In a recent and pioneering study on the importance of the APRI as a predictor of signs of dengue severity, the authors concluded that the APRI proved to be an independent and more valuable predictor to discriminate patients with severe forms of the disease than individual changes in hematological and biochemical parameters [19].…”

Section: Discussionmentioning

confidence: 99%

Aspartate aminotransferase-to-platelet ratio index (APRI): A potential marker for diagnosis in patients at risk of severe malaria caused by Plasmodium vivax

et al. 2019

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Acute infection with Plasmodium vivax, classically associated with benign disease, has been presenting as serious and even fatal disease in recent years. Severe disease is mainly due to biochemical and hematological alterations during the acute phase of infection. In the present cross-sectional study, the aspartate aminotransferase-to-platelet ratio index (APRI) was evaluated as a method for identifying patients at risk of severe vivax malaria. This retrospective study included 130 patients with confirmed P. vivax infection between June 2006 and January 2018. Clinical-epidemiological data were obtained from medical records. Hematological and biochemical parameters were determined using automated equipment. The criteria of severity for infection by Plasmodium falciparum, established by the World Health Organization (WHO), were adapted to classify patients with danger signs of severe vivax malaria. Of the 130 patient’s records evaluated, 19 (14.6%) had one or more signs and symptoms of severe malaria. The mean APRI values among patients with and without severe malaria were 2.11 and 1.09, respectively (p = 0.044). Among those with severe disease, the proportion with an APRI value above 1.50 was 30% compared to the 10% among those without severe disease (p = 0.007). The area under the receiver operating characteristic curve (95% CI), calculated to assess the accuracy of the APRI in discriminating between patients with and without severe disease, was 0.645 (0.494; 0.795). An APRI cutoff of 0.74 resulted in sensitivity of 74.0%, specificity of 56.0%, and accuracy of 65.0%. This study shows that the APRI is elevated in patients with evidence of infection by P. vivax. Based on the good sensitivity found in this study, we conclude that this simple index can serve as a diagnostic biomarker to identify patients at risk of severe disease during the acute phase of P. vivax infection.

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A novel predictor of severe dengue: The aspartate aminotransferase/platelet count ratio index (APRI)

Cited by 21 publications

References 26 publications

Risk prediction for severe disease and better diagnostic accuracy in early dengue infection; the Colombo dengue study

Risk prediction for severe disease and better diagnostic accuracy in early dengue infection; the Colombo dengue study

Trajectories of hepatic and coagulation dysfunctions related to a rapidly fatal outcome among hospitalized patients with dengue fever in Tainan, 2015

Aspartate aminotransferase-to-platelet ratio index (APRI): A potential marker for diagnosis in patients at risk of severe malaria caused by Plasmodium vivax

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