Predictive value of aspartate aminotransferase to alanine aminotransferase ratio for hepatic fibrosis and clinical adverse outcomes in patients with primary biliary cirrhosis.
BACKGROUND
The aspartate aminotransferase to alanine aminotransferase ratio (AAR) was seldom applied for fibrosis assessment in primary biliary cirrhosis (PBC) patients.


OBJECTIVE
To validate the AAR for evaluating hepatic fibrosis, disease severity, and prognosis in patients with PBC.


METHODS
Ninety-two consecutive PBC patients were retrospectively evaluated to validate the AAR for assessing the severity of liver function, the degrees of hepatic fibrosis, and predicting outcomes.


RESULTS
AAR showed modest correlations to Mayo score, model for end-stage liver disease score, and Child-Pugh score (r2=0.156,P<0.001; r2=0.084, P=0.005; r2=0.142, P<0.001, respectively)in evaluating the severity of liver function. For 46 patients who underwent liver biopsy, 35 were in early stage fibrosis and the other 11 were in advanced fibrosis. AAR was significantly higher in patients with advanced fibrosis than those with early fibrosis (mean+/-standard deviation; 1.40+/-0.44 vs. 0.98+/-0.65,P=0.001). The AAR yielded the highest area under the receiver operating curve of 0.847 than Mayo score, model for end-stage liver disease score, and Child-Pugh score in predicting advanced fibrosis. During a median follow-up of 44.5 months, 24 patients expired and 68 patients were alive. Patients with an AAR of 1 or less had significantly better prognosis than their counterparts(P=0.043).


CONCLUSIONS
AAR is a simple and reliable marker to assess liver function and hepatic fibrosis as well as to predict outcomes in PBC patients.
Su
Chien-Wei
CW
Division of Gastroenterology, Department of Medicine, Taipei Veterans Genera Hospital, Taipei, Taiwan.
Chan
Che-Chang
CC
Hung
Hung-Hsu
HH
Huo
Teh-Ia
TI
Huang
Yi-Hsiang
YH
Li
Chung-Pin
CP
Lin
Han-Chieh
HC
Tsay
Shyh-Haw
SH
Lee
Piu-Ching
PC
Lee
Shou-Dong
SD
Wu
Jaw-Ching
JC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000378:metabolism*; D001219:Aspartate Aminotransferases / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000201:enzymology* / Q000503:physiopathology; D008105:Liver Cirrhosis, Biliary / Q000201:enzymology* / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index
D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase