title: Validation of aspartate aminotransferase to platelet ratio for diagnosis of liver fibrosis and prediction of postoperative prognosis in infants with biliary atresia.
abstract: OBJECTIVE
  To validate the value of aspartate aminotransferase to platelet ratio index (APRI) in assessment of liver fibrosis and prediction of postoperative prognosis of biliary atresia (BA) infants from Mainland China.
  
  
  METHODS
  Medical records of 153 BA infants who were hospitalized from January 2010 to June 2013 were reviewed. The efficacy of APRI for diagnosis of liver fibrosis was assessed using the receiver operator characteristic (ROC) curve compared to the pathological Metavir fibrosis score of the liver wedge specimens of 91 BA infants. The prognostic value of preoperative APRI for jaundice persistence, liver injury, and occurrence of cholangitis within 6 mo after KP was studied based on the follow-up data of 48 BA infants.
  
  
  RESULTS
  APRI was significantly correlated with Metavir scores (rs = 0.433; P < 0.05). The mean APRI value was 0.76 in no/mild fibrosis group (Metavir score F0-F1), 1.29 in significant fibrosis group (F2-F3), and 2.51 in cirrhosis group (F4) (P < 0.001). The area under the ROC curve (AUC) of APRI for diagnosing significant fibrosis and cirrhosis was 0.75 (P < 0.001) and 0.81 (P = 0.001), respectively. The APRI cut-off of 0.95 was 60.6% sensitive and 76.0% specific for significant fibrosis diagnosis, and a threshold of 1.66 was 70.6% sensitive and 82.7% specific for cirrhosis. The preoperative APRI in infants who maintained jaundice around 6 mo after KP was higher than that in those who did not (1.86 ± 2.13 vs 0.87 ± 0.48, P < 0.05). The AUC of APRI for prediction of postoperative jaundice occurrence was 0.67. A cut-off value of 0.60 showed a sensitivity of 66.7% and a specificity of 83.3% for the prediction of jaundice persistence. Preoperative APRI had no significant association with later liver injury or occurrence of cholangitis.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Li-Yuan
authors.initials: LY
authors.lastname: Yang
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Fu
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Xiao-Fang
authors.initials: XF
authors.lastname: Peng
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Shu-Yin
authors.initials: SY
authors.lastname: Pang
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Kan-Kan
authors.initials: KK
authors.lastname: Gao
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Zheng-Rong
authors.initials: ZR
authors.lastname: Chen
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Li-Juan
authors.initials: LJ
authors.lastname: He
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Wen
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Le
authors.initials: L
authors.lastname: Li
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Feng-Hua
authors.initials: FH
authors.lastname: Wang
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Jia-Kang
authors.initials: JK
authors.lastname: Yu
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Si-Tang
authors.initials: ST
authors.lastname: Gong
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Hui-Min
authors.initials: HM
authors.lastname: Xia
authors.affiliation: Li-Yuan Yang, Xiao-Fang Peng, Shu-Yin Pang, Kan-Kan Gao, Hai-Ying Liu, Clinical Laboratory, Guangzhou Medical University Affiliated Guangzhou Women and Children's Medical Center, Guangzhou 510120, Guangdong Province, China.
authors.forename: Hai-Ying
authors.initials: HY
authors.lastname: Liu
mesh_terms: D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood*; D001656:Biliary Atresia / Q000097:blood / Q000175:diagnosis* / Q000201:enzymology / Q000473:pathology / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001792:Blood Platelets; D002681:China; D004796:Clinical Enzyme Tests; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000201:enzymology / Q000473:pathology / Q000601:surgery; D008111:Liver Function Tests; D008297:Male; D008499:Medical Records; D010976:Platelet Count; D011171:Portoenterostomy, Hepatic; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases
keywords: Aspartate aminotransferase to platelet ratio index; Biliary atresia; Cirrhosis; Liver fibrosis; Prognosis