Roshan Sneithith1 , Divya Prakash2 , Narasimha K.N.3
BACKGROUND Biliary Atresia (BA) is described as an obliterative cholangiopathy of progressive type resulting in fibrosis and cirrhosis of liver. The proxy marker utilized to detect fibrosis of liver is the aspartate aminotransferase to platelet ratio index (APRi) in liver disorder cases and in biliary atresia affecting old children. The study therefore was done to evaluate the role of simple composite indices like Alanine aminotransferase (ALT) to Platelet index (ALPRi), INR / Platelet ratio in predicting the short-term outcomes in terms of 6-month bilirubin clearance < 2 mg / dL. METHODS This was a longitudinal cohort study conducted over a period of 22 months, in the Department of Paediatric Surgery at Amrita Institute of Medical Sciences, Kochi. The study group comprised of 40 consecutive biliary atresia children who underwent Kasai’s portoenterostomy (KPE) between 2016 and 2018 in whom various routine serum biochemical markers were studied and APRi, ALPRi, INR / Platelet ratio were studied. Demographic information including gender, age in months at the time of Kasai operation, date of surgery, biochemical parameters included serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, total bilirubin, direct bilirubin, r- glutamyl - transpeptidase (GGT), alkaline phosphatase, platelet count, prothrombin time / INR (International Normalised Ratio), TORCH (Toxoplasmosis, Rubella, Cytomegalovirus and HSV ) panel. Each variable was reviewed once prior to surgery and then after 2 weeks, third month and after 6 months of KPE. Early cholangitis was defined as hyperpyrexia (38.0 °C) along with serum total bilirubin, leukocytosis with left shift, and normal to acholic stools within 6 months after KPE. SPSS 22.0 version (IBM) was employed for statistical assessment. ROC analysis, Chi square tests were employed. RESULTS Using a cut-off value of APRi > 0.45 [AUC 0.731 (95 % CI 0.542 – 0.931)] a sensitivity of 78 % and a specificity of 69.2 % for clearance of jaundice at 6 months was seen. APRi at 3 months > 0.505 [(AUC 0.82 (95 %CI)] a sensitivity of 77.8 % and specificity of 76.9 % was seen. Above mentioned cut-off APRi at 2 weeks and 3 months correlated with persistence of jaundice (p 0.610 (AUC 0.78) showed 79.4 % sensitivity and 76.2 % specificity) at 2 weeks post-operatively and it correlated with persistence of jaundice (p<0.05). APRi at 3 months postoperatively with cutoff
