The Role of Aspartate Transaminase to Platelet Ratio Index (APRI) for the Prediction of Non-Alcoholic Fatty Liver Disease (NAFLD) in Severely Obese Children and Adolescents.

Antonello E Rigamonti,Alessandro Sartorio,Eugenia Rondinelli,Adele Bondesan,Silvano G Cella

doi:10.3390/metabo12020155

Abstract

The aspartate transaminase to platelet ratio index (APRI) has been proposed as an easy-to-use biochemical marker in obese adults with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatotic hepatitis (NASH). The objective of the present study was to evaluate the clinical and predictive value of APRI in a paediatric obese population. Seven hundred fifty-seven obese children and adolescents (BMI standard deviation score, SDS: >2.0; age range: 10–18.5 years), not consuming alcohol and without hepatitis B or C, were recruited after having been screened for NAFLD by ultrasonography. A series of demographic, biochemical and clinical parameters was compared between the two subgroups (with or without NAFLD); the same parameters were correlated with APRI; and finally, univariable and multivariable logistic regression was used to evaluate the predictors of NAFLD. NAFLD was diagnosed in about 39% of the entire paediatric population, predominantly in males and in subjects suffering from metabolic syndrome. APRI was correlated with the waist circumference (WC), high-density lipoprotein cholesterol (HDL-C), uric acid, total bilirubin, C reactive protein (CRP) and systolic blood pressure (SBP). Furthermore, APRI was higher in males than females, but independent from steatosis severity and metabolic syndrome. With the univariable analysis, the BMI SDS, triglycerides (TG), insulin, homeostatic model assessment for insulin resistance (HOMA-IR), APRI, uric acid and metabolic syndrome were positive predictors of NAFLD, with female sex being negative predictor. At multivariable analysis; however, only BMI SDS, TG, HOMA-IR and APRI were positive predictors of NAFLD, with female sex being a negative predictor. The accuracy of APRI as a biochemical marker of NAFLD was about 60%.In conclusion, in a large (Italian) paediatric obese population, parameters, such as BMI SDS, TG, HOMA-IR and APRI, were positive predictors of NAFLD, with female sex being a negative predictor and most of the prediction explained by APRI. Nevertheless, APRI appears to be a simple biochemical marker of liver injury rather than of NAFLD/NASH and, moreover, is endowed with a limited accuracy for the prediction/diagnosis of NAFLD.

Highlights

The dramatic increase of obesity prevalence worldwide is accompanied by an unsustainable burden of several non-communicable diseases, including non-alcoholic fatty liver disease (NAFLD), which represents the most frequent cause of chronic liver disease in adults and, not surprisingly, children [1,2]
In children and adolescents, there is evidence that NAFLD is associated with other obesity-related comorbidities, such as dyslipidaemia, insulin resistance, blood hypertension, hyperuricemia, metabolic syndrome and obstructive sleep apnoea [5,6,7,8,9]
The use of the formula deriving from the multivariable logistic regression model [Logit P = −3.815 − (0.681 × female sex) + (0.416 × body mass index standard deviation score (BMI SDS)) + (4.232 × aspartate transaminase to platelet ratio index (APRI)) − (0.0443 × insulin) + (0.346 × HOMA IR) − (0.172 × metabolic syndrome) + (0.00709 × triglycerides) + (0.0843 × uric acid)] (Figure 2) improved the accuracy to 81.34% (p < 0.0001) with a sensitivity of 74.24% and specificity of 100% at a cut-off of Logit P < −0.00146

Summary

Introduction

The dramatic increase of obesity prevalence worldwide is accompanied by an unsustainable burden of several non-communicable diseases, including non-alcoholic fatty liver disease (NAFLD), which represents the most frequent cause of chronic liver disease in adults and, not surprisingly, children [1,2]. The natural history of NAFLD/NASH in childhood, including its progression in early adulthood, is not completely known to date, and this deserves further clinical investigation [2]. Paediatric NAFLD is typically asymptomatic or presents aspecific symptoms, such as abdominal pain, fatigue, irritability and headache [2]. This explains the difficulty to clinically obtain an early diagnosis [10,11] and to estimate the real prevalence of paediatric NAFLD [1]

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Discussion

Conclusion