Aminotransferase -to-Platelet Ratio Index as Predictive Marker for Liver Cirrhosis

Cirrhosis is a condition in which the liver slowly deteriorates and is unable to function normally due to chronic, or long lasting, injury. Liver biopsy is considered as a gold standard for the diagnosis of cirrhosis and has many problems like bleeding, infective peritonitis which limit use of liver biopsies in all patients. Until date there is no noninvasive marker to replace it. Aim to evaluate the Aspartate aminotransferase-to-platelet ratio index (APRI) as a predictive marker for liver cirrhosis. Material and Methods the present study was analytical cross-sectional study carried out during Aug 2016 to Dec 2016, at Al Khartoum State. A total one hundred individuals were enrolled in this study, and classified into two groups 50 patients with liver cirrhosis diagnosed by ultrasound as case group and 50 healthy individuals as control group. Platelet count and Aspartate aminotransferase (AST) were done using Mindary BC3000 plus hematology analyzer and mindary BA-88A Semi-auto Chemistry Analyzer respectively. APRI was calculated for every patient using the formula {(AST / ULN) x 100}/platelet count (109/L).The Predictive value of APRI was evaluated with a receiver-operating characteristics (ROC) curve. Results the level AST was significantly increased in cirrhosis cases than that in control and the platelet count was significantly lower in cirrhosis cases than that in control, furthermore the APRI level was significantly higher in cirrhosis cases than that in control cases (p-value 0.000, 0.000, 0.000) respectively. Also the study found that the level of AST, platelets count and APRI level was not significantly affected by cirrhosis gender (p-value 0.499, 0.870, 0.452) respectively. Also very strong and highly significant correlations were observed between level of AST and APRI (r=0.901**,p >0.01) and medium and highly significant correlations between the level of platelets count and APRI (r=0.413**,P>0.01) .Also the study found that the level of APRI can predict cirrhosis with high degree of efficiency, the sensitivity and specificity of APRI was found to be 96.0% and 100.0% respectively, also positive and negative predictive values were 100.0% and 96.0%respectively, with area under the ROC curve of 0.999,P>0.01 (95% CI) at cut-off 0.64 . This study conclude that there is APRI can predict cirrhosis with high degree of accuracy, and there is no significant difference was observed between cirrhosis genders for the level of APRI and it can be used in areas where facilities for liver biopsy and advanced imaging techniques are not available.