SERUM ASPARATATE TRANSAMINASE PLATELET RATIO INDEX (APRI) IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE IN BANGLADESH

Abstract

Objective: To correlate serum Aspartate transaminase (AST) and Platelet Ratio Index (APRI) with the degree of hepaticfibrosis in patients with non alcoholic fatty liver disease (NAFLD).

Methodology: This study was conducted on patients with NAFLD presenting at Bangabandhu Sheikh Mujib MedicalUniversity, Dhaka, Bangladesh, from July 2007 to June 2008. In all patients, platelet counts and levels of AST weremeasured in the sera. Percutaneous liver biopsy was done in these patients to assess the levels of hepatic fibrosis(HF). APRI was calculated by using the formula; AST×UNL×100/platelet count×109/L.

Results: Out of 30 patients, 28 had HF score of <2, while 2 had HF score of >2. However, high HF score was notassociated with high AST. Based on platelet count, patients were divided into 2 groups; patients with platelet countsof <150,000/mm3 and those with platelet counts of >150,000/mm3. Sensitivity of APRI (cut off level 1.5) to diagnosesignificant fibrosis was 0%, specificity 96.4%, positive predictive value .0%, negative predictive value 93.1% anddiagnostic accuracy 90.0%. On the other hand, when we considered APRI level of >1.5 as an indicator of significantfibrosis, one person was supposed to have hepatic fibrosis score of >2 from APRI value. But, liver histology of thatperson did not support hepatic fibrosis of >2.

Conclusion: APRI has no correlation with degree of hepatic fibrosis in patients with NAFLD and hence cannot beused as a non-invasive marker of fibrosis in patients with NAFLD in Bangladesh. However large scale studies arerequired to confirm these findings.

Key Words: Aspartate Transaminase Platelet Ratio Index, APRI, Non-Alcoholic Fatty Liver Disease (NAFLD), HepaticFibrosis.