title: Aspartate aminotransferase to platelet ratio index correlates with hepatic cirrhosis but not with fibrosis in pediatric patients with intestinal failure.
abstract: OBJECTIVE
  Patients with intestinal failure (IF) require parenteral nutrition (PN) support to obtain enough nutrients to sustain growth; long-term PN use is associated with significant liver damage. The aim of this study was to analyze the use of a noninvasive test, the aspartate aminotransferase to platelet ratio index (APRI), in the diagnosis of liver disease in pediatric patients with IF.
  
  
  METHODS
  Medical records of all Boston Children's Hospital patients who received PN and underwent a liver biopsy from January 2006 until November 2010 were reviewed. Patients with IF with a clinical diagnosis were selected. APRI was calculated as (aspartate aminotransferase [U/L]/upper normal limit) × 100/platelets (10(9) cells/L). Presence of fibrosis and cirrhosis was estimated using the METAVIR score in liver biopsies.
  
  
  RESULTS
  Sixty-two liver biopsies from 48 patients (22 girls) were studied. Mean APRI values in the different METAVIR categories (0-1, 2-3, 4) were 1.80, 1.17, and 4.24, respectively (analysis of variance P = 0.053; Bonferroni test for cirrhosis vs fibrosis P = 0.048). APRI could significantly predict cirrhosis (odds ratio 1.2; 95% confidence interval [CI] 1.001-1.43) but not fibrosis (METAVIR 2-3, odds ratio 1.00; 95% CI 0.86-1.18). Area under the receiver operating characteristic curve for cirrhosis was 0.67 (95% CI 0.45-0.89; P = 0.13).
  
  
  CONCLUSIONS
  APRI, a noninvasive, easy-to-obtain bedside test, significantly predicts cirrhosis but not fibrosis in pediatric patients with IFALD. Because the clinicians need a noninvasive test to differentiate among different stages of liver fibrosis rather than differentiating cirrhosis from normal, we cannot recommend the use of this test in pediatric patients with IFALD for this purpose.
authors.affiliation: Pediatric Gastroenterology and Nutrition, Hospital Universitario Central de Asturias, Oviedo, Asturias 33006, Spain. juanjo.diazmartin@gmail.com
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Díaz
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Gura
authors.forename: Juliamna
authors.initials: J
authors.lastname: Roda
authors.forename: Antonio R
authors.initials: AR
authors.lastname: Perez-Atayde
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.forename: Tom
authors.initials: T
authors.lastname: Jaksic
authors.forename: Clifford W
authors.initials: CW
authors.lastname: Lo
mesh_terms: D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood*; D001706:Biopsy; D001792:Blood Platelets / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005355:Fibrosis / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000628:therapy*; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D008297:Male; D016017:Odds Ratio; D010288:Parenteral Nutrition / Q000009:adverse effects*; D010976:Platelet Count; D012372:ROC Curve; D015203:Reproducibility of Results; D055815:Young Adult
chemical_list: D001219:Aspartate Aminotransferases