Correlation of aspartate aminotransferase-to-platelet ratio index with the METAVIR index in infantile cholestasis

Background: Neonatal cholestasis affects 1 in 2,500 term infants, biliary atresia being the most common and severe cause. Histopathological examination of liver biopsy remains the gold standard for diagnosis, the METAVIR index determining the degree of liver damage. Aspartate aminotransferase-to-platelet ratio index (APRI) is a simple, non-invasive method that can be used to predict liver fibrosis in chronic liver disease.  
Objectives: To study the correlation of APRI and the METAVIR index in subjects with infantile cholestasis.
Method: Infants with cholestasis who underwent liver biopsy and were assessed by the METAVIR index from 2005 to 2023 in Dr. Soetomo Hospital were included retrospectively. APRI at the time of the liver biopsy was calculated. Statistical analysis with Pearson correlation was performed, and a Receiver Operating Characteristic (ROC) curve was used to assess the diagnostic performance of APRI for significant liver fibrosis (=F2) and cirrhosis (=F4).
Results: Twenty-seven patients were included; 12 (44%) were females, with a mean age of 4.7±3.9 months. METAVIR F4 was seen in 8 (30%), F3 in 3 (11%), F2 in 5 (19%), F1 in 9 (33%), and F0 in 2 (7%). Pearson correlation r for APRI and METAVIR was 0.48 (p<0.05). The mean APRI for F2-F4 (significant fibrosis) was 3.55±3.52, and for F0-F1 (no or mild fibrosis), it was 1.80±0.88. The mean APRI for F4 (cirrhosis) was 5.33±4.27, and for F0-F3 (non-cirrhosis), it was 1.78±0.91. From the ROC, the area under the curve for significant fibrosis and cirrhosis was 0.665 and 0.836, respectively.
Conclusion: APRI was positively correlated with the METAVIR index and can be used to predict significant liver fibrosis and cirrhosis in infants with cholestasis.