Evaluation of APRI and FIB-4 indices in early and late-onset preeclampsia

Abstract

Objectives: This study aimed to evaluate the relationships between maternal and neonatal outcomes and the Fibrosis-4 Index (FIB-4) and Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) in healthy pregnancies, late-onset preeclampsia (LOP), and early-onset preeclampsia (EOP).

Methods: A retrospective study was conducted on 239 pregnant women diagnosed with EOP (n=62), LOP (n=56), and healthy pregnancies (n=121) at Etlik City Hospital. Maternal and neonatal outcomes, as well as APRI, and FIB-4 scores were compared. Statistical analyses included ANOVA, chi-square tests, and ROC curve analysis.

Results: EOP was associated with lower gestational age at birth, lower fetal birth weight, and higher NICU admission rates compared to LOP and control groups. APRI scores were significantly elevated in LOP compared to controls (P=0.012). FIB-4 scores were significantly higher in LOP than controls (P=0.005). ROC analysis showed modest predictive power for APRI (AUC=0.614) and FIB-4 (AUC=0.617) in distinguishing LOP from controls. The best cut-off values for APRI and FIB-4 were 0.2347 and 0.65, respectively.

Conclusions: Elevated APRI and FIB-4 scores in LOP suggest their potential roles as complementary markers in preeclampsia management. However, their moderate predictive performance indicates the need for further studies.

Keywords

• Preeclampsia
• APRI (Aspartate Aminotransferase-to-Platelet Ratio Index)
• FIB-4 (Fibrosis-4 Index)

References

1. 1. Bisson C, Dautel S, Patel E, Suresh S, Dauer P, Rana S. Preeclampsia pathophysiology and adverse outcomes during pregnancy and postpartum. Front Med (Lausanne). 2023;10:1144170. doi: 10.3389/fmed.2023.1144170.
2. 2. Jung E, Romero R, Yeo L, et al. The etiology of preeclampsia. Am J Obstet Gynecol. 2022;226(2S):S844-S866. doi: 10.1016/j.ajog.2021.11.1356.
3. 3. MacDonald TM, Walker SP, Hannan NJ, Tong S, Kaitu'u-Lino TJ. Clinical tools and biomarkers to predict preeclampsia. EBioMedicine. 2022;75:103780. doi: 10.1016/j.ebiom.2021.103780.
4. 4. Leybovitz-Haleluya N, Yahav L, Saban A, Eshkoli T, Hershkovitz R, Weintraub A. The use of aspartate aminotransferase to platelet ratio index as a predictor of obstetrical and neonatal adverse outcomes in patients with preeclampsia toxemia. Authorea. September 13, 2024. DOI: 10.22541/au.172621263.32151270/v1.
5. 5. Blanco-Grau A, Gabriel-Medina P, Rodriguez-Algarra F, et al. Assessing Liver Fibrosis Using the FIB4 Index in the Community Setting. Diagnostics (Basel). 2021;11(12):2236. doi: 10.3390/diagnostics11122236.
6. 6. Tolunay HE, Kahraman NC, Varli EN, Reis YA, Celen S, Caglar AT. Can First-trimester AST to Platelet Ratio Index Scores Predict HELLP Syndrome? J Coll Physicians Surg Pak. 2021;31(2):188-192. doi: 10.29271/jcpsp.2021.02.188.
7. 7. Soe MZ, Hayati F, Abdul Rahim SSS. Can First-trimester AST to Platelet Ratio Index Scores Predict HELLP Syndrome? J Coll Physicians Surg Pak. 2022;32(3):409-410. doi: 10.29271/jcpsp.2022.03.409.
8. 8. Bouter AR, Duvekot JJ. Evaluation of the clinical impact of the revised ISSHP and ACOG definitions on preeclampsia. Pregnancy Hypertens. 2020;19:206-211. doi: 10.1016/j.preghy.2019.11.011.

9. 9. Abalos E, Cuesta C, Grosso AL, Chou D, Say L. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):1-7. doi: 10.1016/j.ejogrb.2013.05.005.
10. 10. Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009;33(3):130-137. doi: 10.1053/j.semperi.2009.02.010.
11. 11. Cluver CA, Bergman L, Bergkvist J, et al. Impact of fetal growth restriction on pregnancy outcome in women undergoing expectant management for preterm pre-eclampsia. Ultrasound Obstet Gynecol. 2023;62(5):660-667. doi: 10.1002/uog.26282.
12. 12. Bartsch E, Medcalf KE, Park AL, Ray JG; High Risk of Pre-eclampsia Identification Group. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ. 2016;353:i1753. doi: 10.1136/bmj.i1753.
13. 13. Ellulu MS, Patimah I, Khaza'ai H, Rahmat A, Abed Y. Obesity and inflammation: the linking mechanism and the complications. Arch Med Sci. 2017;13(4):851-863. doi: 10.5114/aoms.2016.58928.
14. 14. Redman CW, Sargent IL. Latest advances in understanding preeclampsia. Science. 2005;308(5728):1592-1594. doi: 10.1126/science.1111726.
15. 15. Afroz F, Sultana N, Rahman A, et al. A comparative study of hepatic enzymes between preeclampsia and normal pregnant women. J Dhaka Med Coll. 2020;29(1):18-22. doi: 10.3329/jdmc.v29i1.51137.
16. 16. Bartal MF, Sibai BM. Gestational hypertension, preeclampsia, and eclampsia. In: Spong CY, Lockwood CJ, editors. Queenan’s Management of High‐Risk Pregnancy. 1st ed. Wiley; 2024. pp. 281-287.
17. 17. İpek G, Tanaçan A, Ağaoğlu Z, Gülçin Baştemur A, Gülen Yıldız E, Şahin D. The role of aspartate aminotransferase to platelet ratio index (APRI) in the first trimester for the prediction of superimposed preeclampsia: A case-control study from a tertiary center. Pregnancy Hypertens. 2024;37:101132. doi: 10.1016/j.preghy.2024.101132.
18. 18. Itakura J, Kurosaki M, Setoyama H, et al. Applicability of APRI and FIB-4 as a transition indicator of liver fibrosis in patients with chronic viral hepatitis. J Gastroenterol. 2021;56(5):470-478. doi: 10.1007/s00535-021-01782-3.
19. 19. Sumida Y, Yoneda M, Tokushige K, et al, Japan Study Group Of Nafld Jsg-Nafld. FIB-4 First in the Diagnostic Algorithm of Metabolic-Dysfunction-Associated Fatty Liver Disease in the Era of the Global Metabodemic. Life (Basel). 2021;11(2):143. doi: 10.3390/life11020143.