title: Utility of liver function tests including aminotransferase-to-platelet ratio index in monitoring liver dysfunction in short-gut infants of varying ages and intestinal lengths.
abstract: OBJECTIVE
  Aspartate aminotransferase-to-platelet ratio index (APRI) has good correlation with liver fibrosis progression in the infant and toddler short-gut population. This study applies laboratory liver function testing, including APRI, to monitor liver dysfunction over time for short-gut infants, with further analysis of at-risk subpopulations.
  
  
  METHODS
  Study inclusion criteria included infants younger than 1 year at initial intestinal resection with subsequent continuous parenteral nutrition dependence of 3 months minimum. Bilirubin, aspartate aminotransferase, alanine aminotransferase, APRI, and biopsies were collected for 26 weeks postresection. Subgroup analysis was stratified by (1) estimated gestational age, (2) age at intestinal resection (AGE), and (3) remaining intestinal length.
  
  
  RESULTS
  Thirty-one children were included, all with AGE younger than 2 months at initial intestinal resection (mean, 13 days). Aminotransferase-to-platelet ratio index was the only marker associated with fibrosis progression (median, APRI by METAVIR grade: F0/F1/F2, 1.9; F3, 5.7; F4, 14.7 [P = .02]). At 8 and 18 weeks postresection, there are separations seen within study subgroups, indicating the onset and progression of liver dysfunction.
  
  
  CONCLUSIONS
  Aminotransferase-to-platelet ratio index is associated with liver fibrosis progression in this population. There are marked changes in liver dysfunction at 8 and 18 weeks postresection, with subgroup differences within estimated gestational age, AGE, and remaining intestinal length.
authors.affiliation: Transplant Division, Department of Surgery, Indiana University, School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: O'Connor
authors.forename: Richard S
authors.initials: RS
authors.lastname: Mangus
authors.forename: A Joseph
authors.initials: AJ
authors.lastname: Tector
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Fridell
authors.forename: Rodrigo M
authors.initials: RM
authors.lastname: Vianna
mesh_terms: D000367:Age Factors; D001219:Aspartate Aminotransferases / Q000097:blood*; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008103:Liver Cirrhosis / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D008107:Liver Diseases / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D008111:Liver Function Tests / Q000706:statistics & numerical data; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D010976:Platelet Count; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012778:Short Bowel Syndrome / Q000097:blood / Q000150:complications / Q000473:pathology*; D013997:Time Factors
chemical_list: D001219:Aspartate Aminotransferases