Aspartate Aminotransferase-to-Platelet ratio index (APRi) in infants with biliary atresia: prognostic value at presentation

J Pediatr Surg. 2013 Apr;48(4):789-95. doi: 10.1016/j.jpedsurg.2012.10.010.


Background: Biliary atresia (BA) is a progressive obliterative cholangiopathy leading to liver fibrosis and cirrhosis. The aspartate aminotransferase-to-platelet ratio index (APRi) has been used in other liver diseases and in older children with BA as a surrogate marker of liver fibrosis. The aim of this study was to calculate APRi at time of presentation and relate this to operative findings and early outcome.

Methods: Prospective single surgeon cohort study of infants with BA (January 1999-December 2010). Initial APRi values were related to other biochemical indices and liver appearance at the time of Kasai portoenterostomy. Data are expressed as median (interquartile range). Non-parametric comparison was performed and a P-value of≤0.05 was regarded as significant.

Results: Overall 260 infants were included in the study. Median APRi was 0.67 (0.43-1.12) at a median age of surgery of 58 (range 14-209) days. APRi correlated with age (rs=0.44; P<0.0001), spleen size (rs=0.48; P<0.0001) and bilirubin (rs=0.45; P<0.0001). Liver assessment at operation was divided into cirrhosis [n=28 (10.8%)] or non-cirrhosis. Using a cut-off value of 1.22 [AUC 0.83 (95% CI 0.73-0.90)] showed a sensitivity of 75% and a specificity of 84% for macroscopic cirrhosis. Native liver survival was significantly different but improved only for those in the lowest APRi quartile (<0.43; P<0.009). APRi values at presentation had no significant association with later development of significant oesophageal varices.

Conclusion: APRi at the time of KP is a useful adjunct in evaluating severity of liver disease in BA at presentation.

MeSH terms

  • Area Under Curve
  • Aspartate Aminotransferases / blood*
  • Biliary Atresia / blood*
  • Biliary Atresia / surgery*
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Liver Cirrhosis / blood
  • Male
  • Platelet Count*
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • ROC Curve


  • Aspartate Aminotransferases