title: Aspartate aminotransferase-to-platelet ratio index is associated with liver cirrhosis in patients undergoing surgery for hepatocellular carcinoma.
abstract: BACKGROUND
  Among various preoperative evaluations of liver function, accurate assessment of liver cirrhosis (LC) is especially important in patients undergoing surgery for hepatocellular carcinoma (HCC).
  
  
  OBJECTIVE
  To explore the most significant laboratory parameter associated with LC in patients undergoing surgery for HCC.
  
  
  METHODS
  From among 588 HCC patients in our collected database who underwent liver surgery, 371 for whom sufficient laboratory data were evaluable, including direct serum fibrosis markers such as hyaluronic acid and type 3 procollagen peptide (P-3-P), were enrolled. Receiver operating characteristic (ROC) curve analysis was used to define the ideal cutoff values of laboratory parameters, and the area under the ROC curve for LC was measured. Univariate and multivariate analyses were performed to clarify the laboratory parameter most significantly associated with LC.
  
  
  RESULTS
  Multivariate analysis of 13 laboratory parameters that had been selected by univariate analysis showed that the aspartate aminotransferase-to-platelet ratio index (APRI) (≤ 0.8/>0.8) (odds ratio, 2.687; 95% confidence interval 1.215-5.940; P = 0.015) was associated with LC, along with the aspartate aminotransferase to alanine aminotransferase ratio, the indocyanine green retention ratio at 15 min (ICG R15), and the level of hyaluronic acid. Among these four parameters associated with LC, ROC curve analysis revealed that APRI (0.757) had the largest area under the ROC (aspartate aminotransferase to alanine aminotransferase 0.505, ICG R15 0.714, and hyaluronic acid 0.743).
  
  
  CONCLUSIONS
  APRI is closely associated with LC in patients undergoing surgery for HCC.
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan. Electronic address: mm-ishizuka@umin.ac.jp.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ishizuka
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Kita
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Mitsugi
authors.initials: M
authors.lastname: Shimoda
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Shozo
authors.initials: S
authors.lastname: Mori
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Iso
authors.affiliation: Anatomic and Diagnostic Pathology, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Yamagishi
authors.affiliation: Anatomic and Diagnostic Pathology, Dokkyo Medical University, Tochigi, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Kojima
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000175:diagnosis; D008113:Liver Neoplasms / Q000601:surgery*; D008875:Middle Aged; D010976:Platelet Count; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Aspartate aminotransferase-to-platelet ratio index; Fibrosis marker; Hepatocellular carcinoma; Liver cirrhosis