The Role of Aspartate Aminotransferase to Platelet Ratio Index as a Non-Invasive Predictor of Variceal Etiology of Upper Gastrointestinal Bleeding
Abstract
Introduction: Non-invasive strategies to predict variceal from non-variceal bleeding will be highly beneficial
for preemptive management of Upper Gastrointestinal Bleeding (UGIB). This study aimed to assess the role
of aspartate aminotransferase (AST) to platelet ratio index (APRI) as a non-invasive predictor of variceal
etiology of UGIB. Methods: This was a retrospective descriptive study conducted at Endoscopy Department
of Dhulikhel Hospital between January 2017 and December 2019 in patients presenting with acute UGIB.
We assessed the diagnostic utility of the APRI score relative to other objective measures by Area Under the
Receiver Operating Characteristic (AUROC) curve analysis. Results: A total of 158 patients with history
of UGIB were included in the study. There were total 123 males (77.8%) and the mean age of the patients
was 50.3±16.1 years. The APRI score performed well in predicting a variceal etiology of acute UGIB, with
AUROC 0.9. When APRI was used at cut-off of 1.3, it had a sensitivity of 84.1% and specificity of 76.8%,
a positive predictive value of 70.7% and a negative predictive value of 89.9% while predicting variceal
etiology of UGIB at presentation. The relative risk of varices at an APRI cut-off of 1.3 is 17.5 with a p-value
of <0.0001. Conclusion: The present study highlighted that APRI score can be used as an objective metric
that helps to predict a variceal etiology of acute UGIB.
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Copyright (c) 2020 Ashish Shrestha, Pasanda Sharma, Anjila Lama, Ram Bahadur Gurung, Dr
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