Validation of aspartate aminotransferase to platelet ratio for diagnosis of liver fibrosis and prediction of postoperative prognosis in infants with biliary atresia

Yang, Lu; Fu, Jie; Peng, Xiaofang; Pang, Shuyin; Gao, Kankan; Chen, Zhengrong; Li, He; Wang, Zhe; Wang, Hui; Li, Le; Wang, Fenghua; Yu, Jian; Xu, Yi; Gong, Sitang; Xia, Huimin; Liu, Haiying

doi:10.3748/wjg.v21.i19.5893

Cited by 35 publications

(33 citation statements)

References 33 publications

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“…Although liver stiffness was a moderately accurate predictor of cirrhosis in the entire patient cohort, none of the tests studied were able to differentiate between Metavir stages F1 through F3. This finding is in line with previous studies comparing liver stiffness and APRI to Metavir fibrosis stage obtained at PE . As in this study, combination scores based on different variables may result in higher accuracy and better discrimination than individual liver function tests but are less feasible for clinical use.…”

Section: Discussionsupporting

confidence: 92%

Noninvasive Evaluation of Liver Fibrosis and Portal Hypertension After Successful Portoenterostomy for Biliary Atresia

et al. 2019

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We investigated noninvasive follow‐up markers for histologic liver fibrosis and portal hypertension (PH) in patients with biliary atresia after successful portoenterostomy (PE). Among children with bilirubin <20 µmol/L after PE (n = 39), Metavir fibrosis stage was evaluated at PE and in follow‐up protocol liver biopsies (n = 83). PH was defined as endoscopically confirmed esophageal varices or thrombocytopenia associated with splenomegaly. The accuracy of liver biochemistry and stiffness in detecting liver fibrosis and PH was analyzed by the area under the receiving operating characteristic curve (AUROC) and multiple regression models. During a median native liver survival of 8.3 years (interquartile range 2.5‐10.8 years), cirrhosis (Metavir F4) had developed in 51% of patients and PH in 54% of patients. Cirrhosis was equally common in all age tertiles of 1.2‐2.1 years (n = 10/27), 3.9‐5.8 years (n = 12/28), and 9.0‐14 years (n = 12/28). In the two oldest age tertiles, histologic liver fibrosis had progressed further in patients with PH than without PH (P < 0.001). PH was accurately predicted by the aspartate aminotransferase‐to‐platelet ratio index (APRI) (cutoff, 0.70; AUROC, 0.92), bile acids (cutoff, 49 µmol/L; AUROC, 0.91), and liver stiffness (cutoff, 16.9 kPa; AUROC, 0.89; P < 0.001 each) across all age tertiles. Liver stiffness was the most accurate predictor of cirrhosis overall (AUROC, 0.82; P < 0.001), whereas bilirubin was >11 µmol/L in the youngest tertile (AUROC, 0.91; P < 0.001), bile acids was >80 µmol/L in the middle tertile (AUROC, 0.81; P = 0.009), and liver stiffness was >24 kPa in the oldest age tertile (AUROC, 0.96; P = 0.002). Conclusion: After successful PE, development of PH associates with progression of liver fibrosis and can be accurately detected by APRI and stiffness. Liver stiffness most accurately identified cirrhosis in older children, whereas biochemical markers of cholestasis closely reflected histologic cirrhosis in younger children.

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Section: Discussionsupporting

confidence: 92%

Noninvasive Evaluation of Liver Fibrosis and Portal Hypertension After Successful Portoenterostomy for Biliary Atresia

et al. 2019

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“…Previous studies have proved that APRI is indeed a surrogate marker for liver fibrosis in the studies of hepatitis C and BA. [17][18][19] However, the association between APRI and the degree of fibrosis in patients with BCMs has not been previously described. Our study is the first to validate the performance of APRI in assessing liver fibrosis in a cohort with BCMs.…”

Section: Discussionmentioning

confidence: 99%

“…The APRI is an example of a non‐invasive biochemical marker presumed to reflect the degree of intrahepatic fibrosis. Previous studies have proved that APRI is indeed a surrogate marker for liver fibrosis in the studies of hepatitis C and BA . However, the association between APRI and the degree of fibrosis in patients with BCMs has not been previously described.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, aspartate aminotransferase‐to‐platelet ratio index (APRI) has been introduced as a non‐invasive biochemical maker to reflect the degree of intrahepatic fibrosis . In patients with biliary atresia, APRI could effectively detect the degree of liver fibrosis, which is also associated with the degradation of Kasai post‐operative jaundice . The role of APRI in the assessment of liver fibrosis and prediction of post‐operative prognosis of BCM still requires further investigation.…”

mentioning

confidence: 99%

“…[16][17][18] In patients with biliary atresia, APRI could effectively detect the degree of liver fibrosis, which is also associated with the degradation of Kasai post-operative jaundice. [18][19][20] The role of APRI in the assessment of liver fibrosis and prediction of post-operative prognosis of BCM still requires further investigation.…”

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confidence: 99%

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Differentiation between cystic biliary atresia and choledochal cyst: A retrospective analysis

Tang

Zhang

Liu

et al. 2017

J Paediatrics Child Health

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Features of Cirrhotic Cardiomyopathy Early in the Lives of Infants With Biliary Atresia Correlate With Outcomes Following Kasai Portoenterostomy

et al. 2022

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Cirrhotic cardiomyopathy (CCM), detected during two‐dimensional echocardiography (2DE), is prevalent in patients with biliary atresia (BA) awaiting transplant. Whether CCM occurs early in the lives of infants with BA is unknown. The aim of this study was to explore the incidence and consequence of CCM in patients with BA, focusing on the earliest ages when 2DE was performed. A cohort of 78 patients with BA at a single center underwent 2DE (median age = 132 days) during the first year of life. Left ventricular mass index (LVMI) to upper limit of normal (ULN) ratio ≥ 1.0 was present in 60% of patients who never underwent Kasai portoenterostomy (KPE; n = 15), 49% with nondraining KPE (n = 41), and 21% with draining KPE (n = 19). Patients with a draining KPE (median age at 2DE = 72 days) had a lower LVMI/ULN ratio (0.75 [interquartile range [IQR] 0.70, 0.91]) compared to those with a nondraining KPE (0.99 [IQR 0.78, 1.17] median age of 141 days; P = 0.012). In those whose 2DE was performed within 7 days of KPE (n = 19, median age of 61 days), the LVMI/ULN ratio was lower in those with a future draining KPE (0.73 [IQR 0.66, 0.75]) compared to the group with a future nondraining KPE (1.03 [IQR 0.88, 1.08], P = 0.002). Logistic regression modeling revealed LVMI/ULN ratio ≥ 1.0 as a predictor of KPE outcome, with an odds ratio of 16.7 (95% confidence interval 1.36‐204; P = 0.028) for a future nondraining KPE compared to those with a LVMI/ULN ratio < 1.0. Conclusion: 2DE early in the lives of patients with BA revealed features of CCM that correlated with future outcomes. If validated in a multicenter study, this could lead to 2DE as a useful clinical tool in the care of infants with BA.

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Validation of aspartate aminotransferase to platelet ratio for diagnosis of liver fibrosis and prediction of postoperative prognosis in infants with biliary atresia

Abstract: 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.

Cited by 35 publications

References 33 publications

Noninvasive Evaluation of Liver Fibrosis and Portal Hypertension After Successful Portoenterostomy for Biliary Atresia

Noninvasive Evaluation of Liver Fibrosis and Portal Hypertension After Successful Portoenterostomy for Biliary Atresia

Differentiation between cystic biliary atresia and choledochal cyst: A retrospective analysis

Features of Cirrhotic Cardiomyopathy Early in the Lives of Infants With Biliary Atresia Correlate With Outcomes Following Kasai Portoenterostomy

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