_id

683a1606c782e11e38d1b140

id

3094

title

AST to Platelet Ratio Index (APRI)

full_title

AST to Platelet Ratio Index (APRI)

short_title

APRI

med_description

Determines the likelihood of hepatic fibrosis and cirrhosis in patients with hepatitis C.

short_description

Predicts hepatitis C-related hepatic fibrosis and cirrhosis.

slug

ast-platelet-ratio-index-apri

description

The AST to Platelet Ratio Index (APRI) determines the likelihood of hepatic fibrosis and cirrhosis in patients with Hepatitis C.

keywords

lin, apri, ast, platelet, cirrhosis, hep c, fibrosis, plt, amino, apri score, ast to platelet ratio index

complaint

[ "Abdominal Pain" ]

formula

APRI = (AST in IU/L) / (AST Upper Limit of Normal in IU/L) / (Platelets in 109/L)

evidence

measurements

[ { "name": "Aspartate Aminotransferase", "unit": "AST", "error_min": "1", "error_max": "10000", "warn_min": "4", "warn_max": "4000", "conversion": "1", "normal_max_si": "41", "normal_max_us": "41", "normal_min_si": "15", "normal_min_us": "15", "units_si": "U/L", "units_us": "U/L" }, { "name": "Platelet Count", "unit": "plt", "error_min": "1", "error_max": "3200", "warn_min": "10", "warn_max": "750", "conversion": "1", "normal_max_si": "350", "normal_max_us": "350", "normal_min_si": "150", "normal_min_us": "150", "units_si": "× 10⁹/L", "units_us": "× 10³/µL" } ]

information

Based on 2011 meta-analysis in Hepatology by Lin et. al:

Significant fibrosis: APRI threshold of 0.7 was 77% sensitive and 72% specific.

Severe fibrosis: APRI threshold of 1.0 was 61% sensitive and 64% specific.

Cirrhosis: APRI threshold of 1.0 was 76% sensitive and 72% specific.

refrences

{ "Clinical Practice Guidelines": [ { "href": "", "text": "" } ], "Manufacturer Website": [ { "href": "", "text": "" } ], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/12883497", "text": "Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38(2):518-26." } ], "Other References": [ { "href": "https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2011.04897.x/full", "text": "Sebastiani G, Halfon P, Castera L, et al. Comparison of three algorithms of non-invasive markers of fibrosis in chronic hepatitis C. Aliment Pharmacol Ther. 2012;35(1):92-104." } ], "Outcomes": [ { "href": "", "text": "" } ], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/19999223", "text": "Khan DA, Fatima Tuz Z, Khan FA, Mubarak A. Evaluation of diagnostic accuracy of APRI for prediction of fibrosis in hepatitis C patients. J Ayub Med Coll Abbottabad 2008; 20: 122-126." }, { "href": "https://onlinelibrary.wiley.com/doi/10.1002/hep.24105/abstract", "text": "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;53:726-36." } ], "Validations": [] }

pearls

• TThe AST to Platelet Ratio Index (APRI) predicts fibrosis and cirrhosis in hepatitis C patients.
• It offers a non-invasive way to predict which patients have cirrhosis without imaging or biopsy.

Points to keep in mind:

• Most experts recommend using the AST Platelet Ratio Index in conjunction with other non-invasive testing especially with intermediate values, as sensitivity and specificity may not be sufficient at these values.
• Caution: If your laboratory has higher-than-typical upper limits of normal for AST this could alter diagnostic performance.

usecase

Patients with hepatitis C being considered for liver biopsy to determine chance of fibrosis or cirrhosis.

reasons

There is no perfect method for predicting fibrosis and cirrhosis in HCV and the APRI uses commonly available laboratory values that may help avoid the need for liver biopsy. The FIB-4 Score may also be useful in these patients as well.

next_advice

This index is among the best validated methods for predicting HCV progression. At extreme values (very high or very low) the APRI can avoid further invasive testing in a substantial proportion of patients. Unfortunately, findings in validation studies suggest only moderate predictive value.

next_actions

The APRI is validated in HCV referral populations, thus extending it to other conditions or populations may be misleading. Upper reference values for AST vary by laboratory, which can also significantly affect results.

next_management

We are unaware of validated management algorithms using the APRI.

diseases

[ "Hepatitis" ]

input_schema

[ { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "AST", "name": "ast", "optional": false, "tips_en": "", "type": "textbox", "unit": "AST" }, { "conditionality": "", "default": 40, "fhir_rules": null, "inct": null, "label_en": "AST upper limit of normal", "name": "uln", "optional": false, "tips_en": "", "type": "textbox", "unit": "AST" }, { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "Platelet count", "name": "plt", "optional": false, "tips_en": "", "type": "textbox", "unit": "plt" } ]

instructions

published

2022-04-21T20:29:12.374Z

purpose

[ "Formula" ]

search_terms

[ "cirrhosis", "hep c", "fibrosis", "plt", "amino" ]

seo

{ "keywords_en": "lin, apri, ast, platelet, cirrhosis, hep c, fibrosis, plt, amino, apri score, ast to platelet ratio index", "meta_description_en": "The AST to Platelet Ratio Index (APRI) determines the likelihood of hepatic fibrosis and cirrhosis in patients with Hepatitis C." }

specialty

[ "Gastroenterology", "Hepatology", "Internal Medicine" ]

departments

[ "Gastrointestinal" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 3081, "short_title_en": "NAFLD Fibrosis Score", "slug": "nafld-non-alcoholic-fatty-liver-disease-fibrosis-score" }, { "calcId": 2200, "short_title_en": "FIB-4 Index", "slug": "fibrosis-4-fib-4-index-liver-fibrosis" }, { "calcId": 78, "short_title_en": "MELD Na (UNOS/OPTN)", "slug": "meld-score-model-end-stage-liver-disease-12-older" } ]

ismed

false

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "gastroenterology" ]

cleaned_use

[ "Patients with hepatitis C being considered for liver biopsy to determine chance of fibrosis or cirrhosis." ]

pub

false