Aspartate-aminotransferase to platelet ratio index score for predicting HELLP syndrome

Şaşmaz, Muhammed İkbal; Ayvaz, Muhammed Ali; Dülger, Ahmet Cumhur; Kaykısız, Eylem Kuday; Güven, Ramazan

doi:10.1016/j.ajem.2019.02.014

Cited by 18 publications

(21 citation statements)

References 22 publications

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“…A total of 80 patients with ICP and 200 control subjects who met the study criteria were analyzed. The median time from the first trimester to the diagnosis of ICP was 24 [17][18][19][20][21] weeks. The pregnant women with ICP were older than the control subjects (median (Q 1 -Q 3 ); 31 (25.75-35.75) and 27 [18][19][20][21][22][23][24][25][26] years, respectively, p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, many studies have focused on the prediction and diagnosis of ICP to enable earlier detection and prevention of ICP. 6,9,16,17,[27][28][29][30] Accordingly, serum levels of irsin, 25 vitamin D3, feutin-B, pregnancy-associated protein-A, and betatrophin have been used as novel biomarkers for the prediction and early diagnosis of ICP. 9,28,29 However, these biomarkers are not in the routine tests of maternal examinations.…”

Section: Discussionmentioning

confidence: 99%

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Liver damage parameters and peripheral blood parameters for prediction and diagnosis of intrahepatic cholestasis in pregnancy

Obut,

Kından,

Ibanoğlu

et al. 2023

J of Obstet and Gynaecol

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ObjectiveIntrahepatic cholestasis of pregnancy (ICP) manifests in late pregnancy. Elevated serum bile acid is a diagnostic criterion: however, its measurement is troublesome. Prediction of ICP by blood markers is not established. Serum bile acid level is associated with liver damage and inflammation. We hypothesized that the following markers could predict the occurrence of ICP and have diagnostic value for it: Liver damage‐indicating scores (albumin–bilirubin [ALBI], Model for End‐Stage Liver Disease [MELD], aspartate aminotransferase‐to‐platelet ratio [APRI]) and inflammatory markers (platelet‐to‐lymphocyte ratio [PLR] and neutrophil‐to‐lymphocyte ratio [NLR]).MethodsEighty ICP patients and 200 controls were studied. The values of MELD, APRI, ALBI, PLR, and NLR were measured in the 1st trimester and at the time of diagnosis.ResultsPatients with ICP had significantly higher ALBI, MELD, and APRI scores both in the first trimester and at diagnosis. Multivariate logistic regression (MLR) showed that age, ALBI, MELD, and APRI scores were statistically significant (p < 0.05). By receiver operating characteristic (ROC) analysis, the sensitivity of MELD, ALBI, APRI, and NLR in the first trimester was 62%, 73%, 58%, and 29%, respectively, and MELD, ALBI, APRI, and PLR at diagnosis was 28%, 38%, 57%, and 8%, respectively, with a fixed false‐positive rate of 10%.ConclusionThis study has demonstrated the usability of the MELD, ALBI, and APRI scores in predicting and diagnosing ICP. They are easy to obtain and might be used in routine practice.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Liver damage parameters and peripheral blood parameters for prediction and diagnosis of intrahepatic cholestasis in pregnancy

Obut,

Kından,

Ibanoğlu

et al. 2023

J of Obstet and Gynaecol

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“…The index also showed use in follow-up for measuring HIV-related hepatotoxicity and as a prognostic disease risk marker in patients with malaria [ 30 , 31 ]. In liver cirrhosis, AST is elevated due to liver damage, while in HUS/aHUS, elevated AST levels are due to hemolysis, as AST can be found in RBC [ 32 ]. Lower levels of ADAMTS-13 result in an inability to cleave ultra-large multimers of the von Willebrand factor resulting in platelet aggregation [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

A Limited Course of Eculizumab in a Child with the Atypical Hemolytic Uremic Syndrome and Pre-B Acute Lymphoblastic Leukemia on Maintenance Therapy: Case Report and Literature Review

Turudić

Milošević

Bilić

et al. 2022

JCM

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Acute lymphoblastic leukemia (ALL) is considered a possible risk for the occurrence of thrombotic microangiopathies. We present a girl with pre-B ALL successfully treated according to the BFM ALL IC-2009 protocol on maintenance therapy followed by aHUS occurrence. This is the seventh case of HUS/aHUS on ALL maintenance therapy and the first with clearly documented eculizumab use in the early stage of aHUS/secondary TMA. Standard and additional parameters were used in aHUS monitoring alongside the reticulocyte production index adjusted for age (RPI/A) and the aspartate aminotransferase-to-platelet ratio index (APRI) as markers of hemolysis and rapid response following treatment. RPI/A and APRI are markers of bone marrow response to anemia serving as red blood cell vs. platelet recovery markers. Together they mark the exact recovery point of thrombotic microangiopathy and serve as a prognostic marker of eculizumab treatment success. During the 8-month treatment and 6-month follow-up, no recurrence of hemolysis, ALL relapse, or renal damage were observed. A systematic review of the literature revealed 14/312 articles; five children had aHUS before the onset of ALL, and two children had both diseases concurrently. At least 3/7 patients are attributed to aHUS, of whom 2/7 have renal damage. Potential undiagnosed/unpublished cases may be assumed.

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“…In a different study conducted on pregnant women with chronic liver disease, APRI was found to be significantly higher in those with cirrhosis than those without cirrhosis, and it was stated that APRI could be used in predicting of live birth in patients with chronic liver disease (11). Also, APRI was investigated in HELLP syndrome by Şaşmaz et al and it was revealed that APRI is a stronger marker than AST in predicting HELLP syndrome (12). In 2020, Tolunay et al investigated the relationship between the APRI and ICP.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of the aspartate aminotransferase to platelet ratio index and aspartate aminotransferase to alanine aminotransferase ratio in early diagnosis of intrahepatic cholestasis in pregnancy

Kale

2021

Med Sci Discov

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Objective: We aimed to investigate the predictive value of the first-trimester aspartate aminotransferase/platelet count ratio index (APRI) and aspartate aminotransferase/alanine aminotransferase ratio for intrahepatic cholestasis in pregnancy (ICP). Material and Methods: The clinical data of patients who admitted to the Obstetrics Department of Umraniye Training and Research Hospital, between 2015-2020 were analyzed retrospectively. The study group consisted of 44 patients with ICP and the control group consisted of randomly selected 92 healthy pregnant women. Results: The two groups were similar in terms of age, BMI, first and third-trimester platelet count and third-trimester hemoglobin level. Patients with ICP had a significantly higher first-trimester APRI and a lower first trimester AST/ALT ratio than the healthy controls (p <0.001, p = 0.001, respectively). According to the ROC analysis, the optimal cut-off value of the APRI to predict ICP was 0.191, with the sensitivity of 0.66 and specificity of 0.66 (AUC: 0,727), and the optimal cut-off value for AST/ALT ratio was 1.07, with the sensitivity of 0.64, and specificity of 0.62 (AUC: 0,681). Conclusion: The first-trimester APRI score and AST/ALT ratio is an easy, inexpensive, and non-invasive tool that may be useful in predicting ICP early.

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Aspartate-aminotransferase to platelet ratio index score for predicting HELLP syndrome

Cited by 18 publications

References 22 publications

Liver damage parameters and peripheral blood parameters for prediction and diagnosis of intrahepatic cholestasis in pregnancy

Liver damage parameters and peripheral blood parameters for prediction and diagnosis of intrahepatic cholestasis in pregnancy

A Limited Course of Eculizumab in a Child with the Atypical Hemolytic Uremic Syndrome and Pre-B Acute Lymphoblastic Leukemia on Maintenance Therapy: Case Report and Literature Review

Predictive value of the aspartate aminotransferase to platelet ratio index and aspartate aminotransferase to alanine aminotransferase ratio in early diagnosis of intrahepatic cholestasis in pregnancy

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