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The following is a summary of “Aspartate aminotransferase-to-platelet ratio index (APRi) as biomarker for liver damage in biliary atresia (BA): a meta-analysis,” published in the January 2025 issue of Journal of Pediatric Surgery by Brits et al.
Biliary atresia (BA) is a progressive pediatric liver disease that leads to cirrhosis in the absence of timely intervention. The aspartate aminotransferase-to-platelet ratio index (APRi) has emerged as a potential non-invasive biomarker for assessing liver fibrosis and cirrhosis severity, offering an alternative to invasive liver biopsy. However, its diagnostic accuracy and standardized cut-off values in pediatric BA remain inadequately defined, particularly across diverse populations. This systematic review and meta-analysis aimed to evaluate the correlation between APRi values and liver fibrosis severity in children with BA, determine its diagnostic performance, and establish appropriate cut-off values for significant fibrosis and cirrhosis. Conducted in accordance with PRISMA guidelines, the study analyzed data from fourteen studies, including retrospective, prospective, and one cross-sectional study, utilizing REDCap for data management and R software for statistical analysis.
Heterogeneity among studies was assessed using the Cochrane Q test and I2 statistics. The identified APRi cut-off values for diagnosing advanced fibrosis (F3) ranged from 0.7 to 2.26, with pooled means and 95% CI calculated to assess diagnostic efficacy. Notable heterogeneity was observed among studies with favorable histological findings, while studies with unfavorable histology exhibited greater consistency in APRi values. Despite the promising potential of APRi, significant variability across studies and limited patient numbers hindered the establishment of a definitive threshold for identifying unfavorable histology in BA. As a result, the clinical utility of APRi in replacing liver biopsy remains uncertain. Further research is necessary to refine its diagnostic application and determine its precise role in clinical decision-making for BA management.
Source: jpedsurg.org/article/S0022-3468(25)00079-X/fulltext
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