How Does Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) Hold Up in Predicting Adverse Outcomes and Prognosis among Patients with Chronic Liver Disease Compared to Other Liver Scoring Systems?

Abstract

BACKGROUND Chronic liver disease is the progressive destruction of liver for 6 months thereby impairing clotting factor formation, bile metabolism, and protein synthesis. ChildPugh-Turcotte (CTP) score, model for end-stage liver disease (MELD) and MELD– sodium (Na) are well established calculated parameters to predict prognosis in chronic liver disease (CLD) patients. This study was conducted to determine as to how aspartate aminotransferase : platelet ratio index (APRI) fares in predicting adverse outcomes and prognosis among patients with chronic liver disease compared to other liver scoring. METHODS This was a cross-sectional hospital-based study of inpatients admitted in the department of General Medicine at Chigateri General Hospital. MELD, MELD-Na, Child-Pugh-Turcotte score, and APRI index, were applied and calculated on all the 50 patients to stage the chronic liver disease, and were followed up for 3 months. RESULTS 19 patients survived and 31 patients died. Among the 31 dead patients, 24 had MELD score of greater than 21.5 points. Sensitivity of MELD & MELD-Na in predicting mortality was 77.42 %. Diagnostic accuracy for both scores was 74 %. All patients who died had a Child Pugh score of greater than 10. The sensitivity of CTP scoring was 100 % and diagnostic accuracy was 98 %. 76 % of our patients experienced severe fibrosis according to APRI index. 4 % experienced significant fibrosis. 20 % of the patients did not have significant fibrosis. The least sensitivity (61.29 %) and diagnostic accuracy (62 %) was observed with APRI. However, positive predictive value was 73.08 % and diagnostic accuracy was 65 % for mortality. CONCLUSIONS Given the minimal investigations required in calculating APRI, it can be used as a fair indicator predicting status of the patient especially in resource limited settings. KEYWORDS Child Pugh Turcotte Score, APRI Index, MELD Score, MELD Na Score