Aim: Liver fibrosis and cirrhosis commonly occurs in patients with biliary atresia (BA). Liver biopsy is the gold standard for evaluating liver fibrosis; however it is invasive and may result in life-threatening complications. A safe and simple alternative to assess liver fibrosis in patients with chronic liver diseases is the aspartate aminotransferase-to-platelet ratio index (APRI).
Patients and Methods: Newly diagnosed BA between May 2009 to March 2015, who underwent the Kasai procedure were included. APRI was calculated for all patients. Liver biopsy was done, and histopathologic analyses were performed using the Metavir classification.
Results: Thirty-five patients (12 boys, median age of 1.9 months) were enrolled. Metavir scores were F4 in 13 patients,, F3 in 11, F2 in 11, and F1 in 0. The areas under the receiver operating characteristics curves for F3 and F4 were 0.92 and 0.91, respectively. Distinct optimal cut-off values of APRI for F3 and F4 were obtained (1.01 and 1.41, respectively). With an APRI of 1.57, the sensitivity and specificity to detect fibrosis were 48% and 52.17% respectively. With an APRI of 1.75, the sensitivity and specificity to detect cirrhosis were 50% and 57.14% respectively.
Conclusion: APRI is not an effective tool to measure fibrosis or cirrhosis in patients with biliary atresia in Indian children.