Gebelikte İntrahepatik Kolestazda Birinci Trimester APRI Skoru ve De-Ritis Oranının Tahmini Rolünün Karşılaştırılması

Abstract

Amaç: APRI skoru ve De Ritis oranı karaciğer hastalıklarıyla ilişkilidir. Literatürde bu belirteçlerin gebeliğin intrahepatik kolestazındaki öngörücü rolü hakkında sınırlı veri bulunmaktadır. Bu çalışmada, gebeliğin intrahepatik kolestazındaki birinci trimester APRI ve De Ritis skorlarının öngörücü rolünü değerlendirmeyi ve karşılaştırmayı amaçladık. Gereç ve yöntem: Retrospektif çalışmamıza toplam 60 intrahepatik gebelik kolestazı ve 60 sağlıklı gebe dahil edildi. Demografik özellikler, ilk trimester aminotransferazları, tam kan sayımı düzeyleri, açlık safra asidi düzeyleri, pıhtılaşma testleri, doğum sonuçları kaydedildi ve gruplar arasında karşılaştırıldı. Receiver operating curve analizi, APRI ve De-Ritis skorunun intrahepatik gebelik kolestazı için öngörücü rolünü belirlemek için kullanıldı. Bulgular: APRI skoru intrahepatik kolestaz grubunda anlamlı olarak daha yüksek (p=0,017) iken De-Ritis oranı daha düşüktü (p=0,002). Açlık safra asidinin APRI skoru ile pozitif korelasyon gösterdiği bulundu (r=0,868, p<0,001). APRI skoru ile De Ritis oranı arasında zayıf pozitif korelasyon vardı (r=0,219, p=0,016). APRI skoru >0,42, %36,67 duyarlılık ve %98,33 özgüllükle intrahepatik kolestazı öngördü (AUC=0,626, p=0,016). De Ritis oranı ≤1,3, %83,33 duyarlılık ve %51,67 özgüllükle intrahepatik kolestazı öngördü (AUC=0,664, p=0,001). İntrahepatik kolestazı öngörmede iki indeks arasında anlamlı fark bulunmadı (p=0,065). Sonuç: Ucuz ve kolay hesaplanabilen ilk trimester APRI ve De Ritis skorları, gebeliğin intrahepatik kolestazını tahmin etmek için kullanılabilir. İki belirteç arasında bir üstünlük olmadığı düşünüldüğünde, her ikisinin de tahmin için kullanılabileceğini düşünmekteyiz.

Keywords

• APRI skoru
• De Ritis oranı
• gebeliğin intrahepatik kolestazı

Project Number

yoktur

Comparison of the Predictive Role of First Trimester APRI Score and De-Ritis Ratio in Intrahepatic Cholestasis of Pregnancy

Abstract

Aim: The APRI score and De Ritis ratio is associated with liver diseases. There is limited data in the literature on the predictive role of these markers in intrahepatic cholestasis of pregnancy. This study aimed to evaluate and compare the predictive role of first trimester APRI and De Ritis scores for intrahepatic cholestasis of pregnancy. Material and methods: A total of 60 intrahepatic cholestasis of pregnancy and 60 healthy pregnant were included in this retrospective study. Demographic features, first trimester aminotransferases, complete blood count levels, fasting bile acid levels, coagulation tests, birth outcomes were recorded and compared between groups. Receiver operating curve was used to determine the predictive role of APRI and De-Ritis score for intrahepatic cholestasis of pregnancy. Results: APRI score was significantly higher (p=0.017) whereas De-Ritis ratio was lower (p=0.002) in intrahepatic cholestasis group. Fasting bile acid was found to be positively correlated with APRI score (r=0.868, p<0.001). There was a weak positive correlation between APRI score and De Ritis ratio (r=0.219, p=0.016). APRI score >0.42 predicted intrahepatic cholestasis with 36.67% sensitivity and 98.33% specificity (AUC=0.626, p=0.016). De Ritis ratio ≤1.3 predicted intrahepatic cholestasis with 83.33% sensitivity and 51.67% specificity (AUC=0.664, p=0.001). No significant difference was found between two index for predicting intrahepatic cholestasis (p=0.065). Conclusion: The first trimester APRI and De Ritis scores, which are cheap and easily available, can be used to predict intrahepatic cholestasis of pregnancy. Considering that there is no superiority between two markers, we suggest that both can be used for prediction.

Keywords

• APRI score
• De Ritis ratio
• intrahepatic cholestasis of pregnancy

Supporting Institution

None

Project Number

yoktur

Ethical Statement

The study was carried out with the permission of Bursa Yuksek Ihtisas Research and Training Hospital Ethics Committee (2024-TBEK 2024/08-13).

Thanks

None

References

1. 1. Hobson SR, Cohen ER, Gandhi S et al. Guideline No. 452: Diagnosis and Management of Intrahepatic Cholestasis of Pregnancy. J Obstet Gynaecol Can 2024;30:102618. doi:10.1016/j.jogc.2024.102618.
2. 2. Ozkan S, Ceylan Y, Ozkan OV, Yildirim S. Review of a challenging clinical issue: Intrahepatic cholestasis of pregnancy. World J Gastroenterol 2015;21(23):7134-41. doi:10.3748/wjg.v21.i23.7134.
3. 3. Kale İ. Predictive value of the aspartate aminotransferase to platelet ratio index and aspartate aminotransferase to alanine aminotransferase ratio in early diagnosis of intrahepatic cholestasis in pregnancy. Medical Science and Discovery 2021;8(11):650-4. doi:10.36472/msd.v8i11.623.
4. 4. Marschall HU, Wikström Shemer E, Ludvigsson JF, Stephansson O. Intrahepatic cholestasis of pregnancy and associated hepatobiliary disease: a population-based cohort study. Hepatology 2013;58(4):1385-91. doi:10.1002/hep.26444.
5. 5. Wikström Shemer E, Marschall HU, Ludvigsson JF, Stephansson O. Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes: a 12-year population-based cohort study. BJOG 2013;120(6):717-23. doi:10.1111/1471-0528.12174.
6. 6. Jamil Z, Khalid S, Khan HMMH et al. Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) as a Novel Score in Early Detection of Complicated Dengue Fever. J Multidiscip Healthc 2024;17:2321-30. doi:10.2147/JMDH.S459929.
7. 7. De Matteis C, Cariello M, Graziano G et al. AST to Platelet Ratio Index (APRI) is an easy-to-use predictor score for cardiovascular risk in metabolic subjects. Sci Rep 2021;11(1):14834. doi:10.1038/s41598-021-94277-3.
8. 8. Şaşmaz Mİ, Ayvaz MA, Dülger AC, Kuday Kaykısız EK, Güven R. Aspartate-aminotransferase to platelet ratio index score for predicting HELLP syndrome. Am J Emerg Med 2020;38(3):459-462. doi:10.1016/j.ajem.2019.02.014.

9. 9. Botros M, Sikaris KA. The de ritis ratio: the test of time. Clin Biochem Rev 2013;34(3):117-30.
10. 10. Parmar KS, Singh GK, Gupta GP, Pathak T, Nayak S. Evaluation of De Ritis ratio in liver-associated diseases. International Journal of Medical Science and Public Health 2016;5(9):1783. doi:10.5455/ijmsph.2016.24122015322.
11. 11. Visaria A, Pai S, Cheung M, Ahlawat S. Association between aspartate aminotransferase-to-alanine aminotransferase ratio and insulin resistance among US adults. Eur J Gastroenterol Hepatol 2022;34(3):316-23. doi:10.1097/MEG.0000000000002215.
12. 12. Ovadia C, Seed PT, Sklavounos A et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses. Lancet 2019;393(10174):899-909. doi:10.1016/S0140-6736(18)31877-4.
13. 13. Labbe C, Delesalle C, Creveuil C, Dreyfus M. Cholestases intrahepatiques gravidiques (CIG) précoces et tardives:étude des complications materno-fœtales [Early and later intrahepatic cholestasis of pregnancy (ICP): Study of adverse pregnancy outcomes]. Gynecol Obstet Fertil Senol 2018;46(4):388-94. doi:10.1016/j.gofs.2018.01.003.
14. 14. Tayyar AT, Tayyar A, Atakul T et al. Could first- and second-trimester biochemical markers for Down syndrome have a role in predicting intrahepatic cholestasis of pregnancy? Arch Med Sci 2018;14(4):846-50. doi:10.5114/aoms.2017.69865.
15. 15. Zhang Y, Lan X, Cai C et al. Associations between Maternal Lipid Profiles and Pregnancy Complications: A Prospective Population-Based Study. Am J Perinatol 2021;38(8):834-40. doi:10.1055/s-0039-3402724.
16. 16. Abu-Hayyeh S, Ovadia C, Lieu T et al. Prognostic and mechanistic potential of progesterone sulfates in intrahepatic cholestasis of pregnancy and pruritus gravidarum. Hepatology 2016;63(4):1287-98. doi:10.1002/hep.28265.
17. 17. Tolunay HE, Kahraman NÇ, Varlı EN et al. First-trimester aspartate aminotransferase to platelet ratio index in predicting intrahepatic cholestasis in pregnancy and its relationship with bile acids: A pilot study. Eur J Obstet Gynecol Reprod Biol 2021;256:114-7. doi:10.1016/j.ejogrb.2020.11.014.
18. 18. Gok K, Takmaz T, Kose O et al. Can first-trimester aspartate aminotransferase/platelet ratio index score predict intrahepatic cholestasis of pregnancy? Hepatol Forum 2023;4(1):30-4. doi:10.14744/hf.2022.2022.0031.
19. 19. Li SM, Li GX, Fu DM, Wang Y, Dang LQ. Liver fibrosis evaluation by ARFI and APRI in chronic hepatitis C. World J Gastroenterol 2014;20(28):9528-33. doi:10.3748/wjg.v20.i28.9528.
20. 20. Suominen JS, Lampela H, Heikkilä P, Lohi J, Jalanko H, Pakarinen MP. APRI predicts native liver survival by reflecting portal fibrogenesis and hepatic neovascularization at the time of portoenterostomy in biliary atresia. J Pediatr Surg 2015;50(9):1528-31. doi:10.1016/j.jpedsurg.2014.11.046.
21. 21. Lin ZH, Xin YN, Dong QJ et al. Performance of the aspartate aminotransferase-to-platelet ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis. Hepatology 2011;53(3):726-36. doi:10.1002/hep.24105.
22. 22. Cemortan M, Iliadi-Tulbure C, Sagaidac I, Cernetchi O. Assessment of aspartate aminotransferase to Platelet Ratio Index and Fibrosis-4 Index score on women with intrahepatic cholestasis of pregnancy. AJOG Glob Rep 2024;4(2):100337. doi:10.1016/j.xagr.2024.100337.
23. 23. Sakcak B, Denizli R, Farisoğulları N et al. Second-Third Trimester Aspartate Aminotransferase to Platelet Ratio Index in Predicting in Intrahepatic Cholestasis of Pregnancy and its Relationship with Neoanatal Intensive Care Unit Requirement: A Case Control Study From a Tertiary Hospital. JGON 2023;20(3):1863-6.
24. 24. Saadi R, Saban A, Weintraub AY et al. The association between aspartate aminotransferase (AST) to platelets (PLT) ratio (APRI) and the development of intrahepatic cholestasis in pregnancy and other related complications. Arch Gynecol Obstet 2024;310: 427-32. doi:10.1007/s00404-024-07383-8.
25. 25. Peker A, Tanaçan A, İpek G, Ağaoğlu Z, Şahin D. Role of aspartate aminotransferase to platelet ratio in the prediction and prognosis of intrahepatic cholestasis of pregnancy: A case-control study from a tertiary center. Int J Gynaecol Obstet 2024;164(2):656-61. doi:10.1002/ijgo.15016.
26. 26. Eyisoy ÖG, Taşdemir Ü, Eriç Özdemir M et al. Aspartate aminotransferase to platelet ratio index (APRI) score: is it useful in patients with intrahepatic cholestasis of pregnancy? J Matern Fetal Neonatal Med 2022;35(25):10137-42. doi:10.1080/14767058.2022.2122036.