Evaluation of aspartate amino transferase to platelet ratio index as a non invasive marker for liver cirrhosis

Mohammed Feros, Lokesh Shanmugam


Background: Cirrhosis is a condition in which the liver slowly deteriorates and is unable to function normally due to chronic 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.

Methods: A comparative study was done (90 cases and 90 controls) who fulfilled the inclusion criteria in a tertiary center.

Results: The present study was conducted using a total of 180 participants, 90 USG diagnosed cases of liver cirrhosis was compared with 90 healthy controls. The mean AST level in the cirrhosis was 66.50±27.06 as compared to 21.26±6.52 in controls which was statistically significant. In this study the sensitivity and specificity of APRI was found to be 100.0% and 84.44% respectively, and the positive and negative predictive values were 86.54% and 100% respectively with significantly Area under the curve (AUC) (0.999, P>0.01).

Conclusions: A simple index like Aspartate platelet ratio index, consisting of 2 readily available laboratory results (AST level and platelet count), can predict cirrhosis with a high degree of accuracy.


Aspartate platelet ratio index, Aspartate amino transferase, Complete blood count, Cirrhosis, Liver function test, Ultrasound

Full Text:



Forestier J, Dumortier J, Guillaud O, Ecochard M, Roman S, Boillot O, et al. Noninvasive diagnosis and prognosis of liver cirrhosis: a comparison of biological scores, elastometry, and metabolic liver function tests. Eur J Gastroenterol Hepatol. 2010 May;22(5):532-40.

Carey E, Carey WD. Noninvasive tests for liver disease, fibrosis, and cirrhosis: Is liver biopsy obsolete? Cleve Clin J Med. 2010 Aug;77(8):519-27.

Poynard T, Imbert-Bismut F, Munteanu M, Messous D, Myers RP, Thabut D, et al. Overview of the diagnostic value of biochemical markers of liver fibrosis (FibroTest, HCV FibroSure) and necrosis (ActiTest) in patients with chronic hepatitis C. Comp Hepatol. 2004 Sep 23;3:8.

Lackner C, Struber G, Liegl B, Leibl S, Ofner P, Bankuti C, et al. Comparison and validation of simple noninvasive tests for prediction of fibrosis in chronic hepatitis C. Hepatol Baltim Md. 2005 Jun;41(6):1376-82.

Lesmana CRA, Salim S, Hasan I, Sulaiman AS, Gani RA, Pakasi LS, et al. Diagnostic accuracy of transient elastography (FibroScan) versus the aspartate transaminase to platelet ratio index in assessing liver fibrosis in chronic hepatitis B: the role in primary care setting. J Clin Pathol. 2011 Oct;64(10):916-20.

Fallatah HI. Noninvasive Biomarkers of Liver Fibrosis: An Overview. Advances in Hepatology. 2014. Available at: Accessed 11 October 2018.

Wai C-T, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatol Baltim Md. 2003 Aug;38(2):518-26.

Khan DA, Fatima-Tuz-Zuhra null, Khan FA, Mubarak A. Evaluation of diagnostic accuracy of APRI for prediction of fibrosis in hepatitis C patients. J Ayub Med Coll Abbottabad. 2008 Dec;20(4):122-6.

Carvalho-Filho RJ, Schiavon LL, Narciso-Schiavon JL, Sampaio JP, Lanzoni VP, Ferraz MLG, et al. Optimized cutoffs improve performance of the aspartate aminotransferase to platelet ratio index for predicting significant liver fibrosis in human immunodeficiency virus/hepatitis C virus co-infection. Liver Int Off J Int Assoc Study Liver. 2008 Apr;28(4):486-93.

Martin J, Khatri G, Gopal P, Singal AG. Accuracy of ultrasound and noninvasive markers of fibrosis to identify patients with cirrhosis. Dig Dis Sci. 2015 Jun;60(6):1841-7.

Jin W, Lin Z, Xin Y, Jiang X, Dong Q, Xuan S. Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis B-related fibrosis: a leading meta-analysis. BMC Gastroenterol. 2012 Feb 14;12:14.

Xianghong G, Guanping C, Fenghua Y, Jiayin W. Changes in platelet functional parameters and CD62 P expression in liver cirrhosis. Afr Health Sci. 2013 Dec;13(4):1079-83.

Murali AR, Attar BM, Katz A, Kotwal V, Clarke PM. Utility of Platelet Count for Predicting Cirrhosis in Alcoholic Liver Disease: Model for Identifying Cirrhosis in a US Population. J Gen Intern Med. 2015 Aug;30(8):1112-7.

Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, et al. Does this patient with liver disease have cirrhosis? JAMA. 2012 Feb 22;307(8):832-42.

Ceylan B, Mete B, Fincanci M, Aslan T, Akkoyunlu Y, Ozguneş N, et al. A new model using platelet indices to predict liver fibrosis in patients with chronic hepatitis B infection. Wien Klin Wochenschr. 2013 Aug;125(15-16):453-60.

Purnak T, Olmez S, Torun S, Efe C, Sayilir A, Ozaslan E, et al. Mean platelet volume is increased in chronic hepatitis C patients with advanced fibrosis. Clin Res Hepatol Gastroenterol. 2013 Feb;37(1):41-6.

Bernardi M, Maggioli C, Zaccherini G. Human albumin in the management of complications of liver cirrhosis. Crit Care. 2012;16(2):211.

Ghadir MR, Riahin AA, Havaspour A, Nooranipour M, Habibinejad AA. The relationship between lipid profile and severity of liver damage in cirrhotic patients. Hepat Mon. 2010;10(4):285-8.

Phukan JP, Sinha A, Deka JP. Serum lipid profile in alcoholic cirrhosis: A study in a teaching hospital of north-eastern India. Niger Med J J Niger Med Assoc. 2013;54(1):5-9.

Mandal SK, Sil K, Chatterjee S, Ganguly J, Chatterjee K, Sarkar P, et al. A Study on Lipid Profiles in Chronic Liver Diseases -. Natl J Med Res. 2013;3(1):70-2.

Silva RG da, Fakhouri R, Nascimento TVB, Santos IM, Barbosa LMM. Aspartate aminotransferase-to-platelet ratio index for fibrosis and cirrhosis prediction in chronic hepatitis C patients. Braz J Infect Dis Off Publ Braz Soc Infect Dis. 2008;12(1):15-9.

Starr SP, Raines D. Cirrhosis: diagnosis, management, and prevention. Am Fam Physician. 2011 Dec 15;84(12):1353-9.

Ikura Y, Ohsawa M, Okada M, Iwai Y, Wakasa K. The significance of platelet consumption in the development of thrombocytopenia in patients with cirrhosis. Am J Med Sci. 2013 Sep;346(3):199-203.

Sirli R, Sporea I. Aspartate aminotransferase to platelet ratio index for the assessment of liver fibrosis severity in patients with chronic hepatitis. Hepat Mon. 2011 Jul 1;11(7):560-1.