Validation of aspartate aminotransferase to platelet ratio for diagnosis of liver fibrosis and prediction of postoperative prognosis in infants with biliary atresia

Table 1 General characteristic of infants with biliary atresia by Metavir stage n (%)

Parameter, mean ± SD	All	Metavir stage
	(n = 91)	F0	F1	F2	F3	F4	P value
		(n = 2)	(n = 23)	(n = 35)	(n = 21)	(n = 10)
Age (d)	83 (36)	45 (37)	70 (37)	84 (22)	85 (34)	110 (62)	0.027
AST (U/L)	285 (182)	233 (259)	221 (114)	310 (230)	307 (169)	306 (125)	NS
ALT (U/L)	179 (105)	127 (152)	175 (128)	197 (104)	152 (78)	198 (94)	NS
ALP (U/L)	541 (221)	366 (235)	511 (207)	569 (220)	518 (242)	597 (225)	NS
γ-GT (U/L)	895 (685)	892 (841)	751 (632)	1009 (810)	972 (610)	662 (404)	NS
TP (g/L)	58.3 (4.8)	57.6 (13.9)	57.9 (5.7)	58.8 (4.2)	58.7 (4.0)	56.5 (4.5)	NS
ALB (g/L)	40.0 (4.7)	41.4 (3.9)	40.0 (3.8)	40.6 (5.4)	40.0 (4.2)	38.2 (5.3)	NS
TBIL (μmol/L)	202.8 (75.8)	313.5 (44.6)	192.5 (71.9)	193.5 (60)	222.5 (100.6)	195.4 (65.6)	NS
DBIL (μmol/L)	147.6 (55.2)	133.6 (92.6)	138.9 (52.9)	144.2 (41.3)	170.3 (75.6)	134.9 (43.1)	NS
TBA (μmol/L)	166.7 (68.5)	71.9 (36.9)	133.0 (53.8)	175.2 (65.6)	194.9 (64.0)	177.2 (84.5)	0.007
PLT (× 109/L)	447 (162)	713 (127)	498 (126)	454 (151)	435 (155)	279 (165)	0.000
INR	1.03 (0.26)	1.69 (1.06)	1.01 (0.13)	1.00 (0.11)	1.00 (0.12)	1.18 (0.59)	0.001
AST/ALT	1.84 (1.13)	2.14 (0.52)	1.84 (1.80)	1.64 (0.65)	2.21 (1.06)	1.66 (0.52)	NS
APRI	1.28 (1.05)	0.50 (0.52)	0.79 (0.45)	1.26 (0.93)	1.35 (0.93)	2.51 (1.68)	0.000

SD: Standard deviation; NS: Not significant; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; γ-GT: Gamma-glutamyl transpeptidase; TP: Total protein; ALB: Albumin; TBIL: Total bilirubin; DBIL: Direct bilirubin; TBA: Total bile acids; INR: International normalized ratio; APRI: Aspartate aminotransferase to platelet ratio index. Reference intervals: AST (5-60 U/L), ALT (3-35 U/L), ALP (118-390 U/L), γ-GT (13-57 U/L), TP (60-80 g/L), ALB (35-50 g/L), TBIL (2-17 μmol/L), DBIL (0-7 μmol/L), TBA (0-15 μmol/L), PLT (140-440 × 10⁹/L), INR (0.8-1.5).

Table 2 Comparison of liver injury parameters in biliary atresia patients according to aminotransferase to platelet ratio index cut-off value n (%)

Parameter	APRI for significant fibrosis (cut-off = 0.95)				APRI for cirrhosis (cut-off = 1.66)
	At KP		6 mo after KP		At KP		6 mo after KP
	≤ 0.95(n = 24)	> 0.95(n = 24)	≤ 0.95(n = 24)	> 0.95(n = 24)	≤ 1.66(n = 38)	> 1.66(n = 10)	≤ 1.66(n = 38)	> 1.66(n = 10)
AST (U/L)	194 (83)	496 (721)1	210 (188)	149 (93)	234 (92)	785 (1077)2	183 (159)	165 (102)
ALT (U/L)	136 (73)	293 (327)1	163 (128)	126 (96)	164 (100)	407 (474)2	139 (112)	168 (121)

All data are shown as mean (SD).

¹Compared with non-significant fibrosis group, P < 0.05; but it decreased to the same levels as non-significant fibrosis group. There were no obvious changes of AST and ALT in non-significant fibrosis group before and after KP.

²Compared with non-cirrhosis group, P < 0.01; but it decreased to the same levels as non-cirrhosis group. There also were no obvious changes of AST and ALT in non-cirrhosis group before and after KP. APRI: Aminotransferase to platelet ratio index.