Clinical Evaluation of APRI as a Non-Invasive Screening Tool for Liver Fibrosis and Cirrhosis in Faisalabad, Punjab, Pakistan
DOI:
https://doi.org/10.66021/pakmcr1347Keywords:
Aspartate Transaminase-to-Platelet Ratio Index (APRI), Liver Cirrhosis, Liver Fibrosis, Chronic Liver Disease, Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Aspartate Aminotransferase (AST), Platelet Count, Non-Invasive Diagnosis, ROC Curve AnalysisAbstract
The Aspartate Transaminase-to-Platelet Ratio Index (APRI) has emerged as a simple, inexpensive, non-invasive alternative based on laboratory parameters that are routinely available. The objective of the present study was to assess the feasibility of APRI as an inexpensive screening test for liver cirrhosis in adult population of Faisalabad, Punjab, Pakistan. A total of 275 persons were screened, out of which 247 participants (128 females and 119 males) aged 18-70 years were included and the subjects were selected by non-probability purposive sampling technique. Patients who had a history of dengue fever, malaria, blood transfusion, non-alcoholic fatty liver disease (NAFLD), hepatic malignancies, or liver transplantation were excluded from the study. The formula for APRI scores was: (AST ÷ Upper Limit of Normal AST) ÷ Platelet Count (×10⁹/L) × 100. Data were analyzed statistically using IBM SPSS software including the Spearman's rho correlation and receiver operating characteristic (ROC) curve analysis. The most prevalent age groups were 31–45 years (37.7%) and 46–60 years (32.8%). The distribution of APRI scores showed that 15.0% (37) of the participants had APRI scores ≥2.0, representing severe cirrhosis and 29.6% (73) of participants had APRI scores >1.5, indicating significant fibrosis. Moreover, 137 of the participants (55.5%) had APRI values lesser than 0.5. Spearman's rho analysis showed a significant negative correlation between the platelet count and AST level (r = −0.817, p < 0.01). APRI had a very strong positive correlation with AST levels (r = 0.951, p < 0.01), a strong negative correlation with platelet count (r = −0.930, p < 0.01). The area under the receiver operating characteristics curve (AUC) was 1.000 (95% CI: 1.000–1.000; p < 0.001), signifying good discriminatory capacity of APRI for liver cirrhosis.
The results prove that the APRI is a very accurate, reliable and cost-effective non-invasive screening test for liver fibrosis and cirrhosis. It is simple, easily accessible, and can be especially beneficial in resource-limited healthcare environments in Pakistan, where it can aid in the timely diagnosis, timely clinical interventions, and better health outcomes for patients.
