ArticleJournal of the colleges of medicine of South Africa2026
Analysis of aspartate aminotransferase-to-platelet ratio index and liver fibrosis in biliary atresia.
Article in Journal of the colleges of medicine of South Africa, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The aspartate aminotransferase-to-platelet ratio index (APRi) has been proposed as a non-invasive biomarker of liver injury in biliary atresia (BA). However, conflicting evidence and varying cutoff values have left its association with histologically confirmed liver damage uncertain. This study assessed the relationship between APRi and liver injury severity (Meta-Analysis of Histological Data in Viral Hepatitis [METAVIR] F0-F4) in BA and evaluated its predictive value. Methods: A retrospective analytical review of electronic records was conducted for all BA patients treated at a South African academic hospital between 01 January 2009 and 31 December 2019. Results: Sixty-seven patients were included, 74.6% of whom were female. The most common subtypes were cytomegalovirus (CMV) immunoglobulin M-positive (IgM+) BA (34.3%) and isolated BA (31.3%); about one-third could not be classified because CMV serology was unavailable. Liver biopsy METAVIR scores were F1 (8.3%), F2 (50.0%), F3 (18.3%) and F4 (23.3%). In a sub-analysis ( Conclusion: Aminotransferase-to-platelet ratio index should not replace established clinical decision-making but may provide useful adjunctive information alongside clinical, biochemical and histological assessment. These findings provide contextual evidence from a South African resource-limited setting and support prospective multicentre validation before routine clinical implementation. Contribution: The study contributes evidence supporting continued evaluation of APRi as an adjunctive non-invasive biomarker in BA in the South African setting.
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