WOFAPS 2025 8th World Congress of Pediatric Surgery

Elizabeth Brits ¹, Stephen Brown ², Lezelle Botes ³, Michael Pienaar ⁴

¹ Paediatric Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
² Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
³ Department of Health Sciences, Central University of Technology, Bloemfontein, South Africa
⁴ Division of Critical Care, Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa

Background. The aspartate aminotransferase to platelet ratio index (APRi) is proposed as a non-invasive biomarker for liver injury in biliary atresia (BA). Due to conflicting evidence and cutoff values, the link between APRi and histologically observed liver damage remains unclear.

Objective. To associate APRi with liver injury degrees (METAVIR scores F0–F4) in BA patients and assess its predictive value as a marker for liver damage, aiding management decisions.

Methods. Retrospective analytical review of all BA patients treated at a South Africa academic hospital from 1 January 2009 to 31 December 2019.

Results. Sixty-seven BA patients, mostly female (74.6%), were included. The most common type was cytomegalovirus (CMV)- immunoglobulin M positive (IgM +) BA (34.3%), isolated BA (31.3%), and BA splenic malformation (3.0%). About a third was not assigned a type. HIV exposure at birth was 26.9%, with 1.5% testing positive. Liver biopsies showed METAVIR scores: F1 (8.2%), F2 (49.2%), F3 (18%), and F4 (24.6%). Sub-analysis (n=39) showed APRi modestly distinguished between ≤F2 and ≥F3 histology with a cutoff of 2.69. Decision curve analysis indicated that the APRi model adds value at most threshold probabilities, with an odds ratio of 1.25 (95% CI 0.94–1.92, p=0.2).

Conclusion. The correlation between APRi value and liver fibrosis can guide clinical decisions, especially between Kasai hepatoportoenterostomy and primary liver transplantation in infants. A cutoff of 2.69 offers sensitivity and specificity metrics for patients under 120 days. Further validation is needed, but this research highlights APRi's potential to improve BA management and reduce unnecessary procedures.