title: Utility of Aminotransferase/Platelet Ratio Index to Predict Liver Fibrosis in Intestinal Failure-Associated Liver Disease in Pediatric Patients.
abstract: Intestinal failure-associated liver disease (IFALD) is a frequent indication for intestinal transplantation. Liver biopsy (LBX) is the gold standard test for its diagnosis. Identifying noninvasive markers of fibrosis progression would be of considerable clinical use. Aspartate aminotransferase/platelet ratio index (APRI) has a good correlation in adult patients with chronic liver disease; few studies have been performed in children with IFALD.
  
  
  
  To evaluate APRI in a cohort of children with IFALD.
  
  
  
  Retrospective analysis of a prospective database of patients <18 years with severe intestinal failure and at least 1 LBX, registered in our unit from March 2006 to December 2014.
  
  
  
  Forty-nine LBX were done on 36 patients: 20 were male, and 31 had short gut. Fibrosis was found in 71% of LBX. Biopsies were grouped according to the fibrosis stage (METAVIR [M]): (1) group 1 (G1) LBX with M 0, 1, 2 (n = 33) and (2) group 2 (G2) LBX with M 3, 4 (n = 16). The median APRI score was 0.92 (interquartile range [IQR] 0.63-1.50) for G1 and 2.50 (IQR 1.81-5.82) for G2 ( P = .001) The c statistic of the receiving operating characteristic curve was 0.79 (95% CI 0.64-0.94; P < .001). The analyses allowed identifying a cutoff value for APRI of 1.6 as the point with the best sensitivity (81%) and specificity (76%) to predict advanced fibrosis.
  
  
  
  APRI in this cohort of patients shows that a score >1.6 correlates with advanced fibrosis.
authors.affiliation: 1 Multi-Organ Transplant Institute, Hospital Universitario Fundación Favaloro, CABA, Argentina.
authors.forename: Carolina
authors.initials: C
authors.lastname: Rumbo
authors.affiliation: 1 Multi-Organ Transplant Institute, Hospital Universitario Fundación Favaloro, CABA, Argentina.
authors.forename: María Inés
authors.initials: MI
authors.lastname: Martinez
authors.affiliation: 2 Department of Pathology, Hospital Universitario Fundación Favaloro, CABA, Argentina.
authors.forename: Ana
authors.initials: A
authors.lastname: Cabanne
authors.affiliation: 3 Department of Pediatrics, Hospital Universitario Fundación Favaloro, CABA, Argentina.
authors.forename: Julio
authors.initials: J
authors.lastname: Trentadue
authors.affiliation: 1 Multi-Organ Transplant Institute, Hospital Universitario Fundación Favaloro, CABA, Argentina.
authors.forename: Adriana
authors.initials: A
authors.lastname: Fernández
authors.affiliation: 1 Multi-Organ Transplant Institute, Hospital Universitario Fundación Favaloro, CABA, Argentina.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Gondolesi
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets / Q000737:chemistry*; D002648:Child; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D008099:Liver / Q000187:drug effects / Q000378:metabolism; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D008297:Male; D008499:Medical Records; D010288:Parenteral Nutrition; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: aspartate aminotransferase/platelet ratio index; intestinal failure; intestinal transplant; liver fibrosis; parenteral nutrition