The Role of Aspartate Transaminase to Platelet Ratio Index (APRI) for the Prediction of Non-Alcoholic Fatty Liver Disease (NAFLD) in Severely Obese Children and Adolescents

The aspartate transaminase to platelet ratio index (APRI) has been proposed as an easyto-
use biochemical marker in obese adults with non-alcoholic fatty liver disease (NAFLD) and
non-alcoholic steatotic hepatitis (NASH). The objective of the present study was to evaluate the
clinical and predictive value of APRI in a paediatric obese population. Seven hundred fifty-seven
obese children and adolescents (BMI standard deviation score, SDS: >2.0; age range: 10–18.5 years),
not consuming alcohol and without hepatitis B or C, were recruited after having been screened
for NAFLD by ultrasonography. A series of demographic, biochemical and clinical parameters
was compared between the two subgroups (with or without NAFLD); the same parameters were
correlated with APRI; and finally, univariable and multivariable logistic regression was used to
evaluate the predictors of NAFLD. NAFLD was diagnosed in about 39% of the entire paediatric
population, predominantly in males and in subjects suffering from metabolic syndrome. APRI was
correlated with the waist circumference (WC), high-density lipoprotein cholesterol (HDL-C), uric
acid, total bilirubin, C reactive protein (CRP) and systolic blood pressure (SBP). Furthermore, APRI
was higher in males than females, but independent from steatosis severity and metabolic syndrome.
With the univariable analysis, the BMI SDS, triglycerides (TG), insulin, homeostatic model assessment
for insulin resistance (HOMA-IR), APRI, uric acid and metabolic syndrome were positive predictors
of NAFLD, with female sex being negative predictor. At multivariable analysis; however, only BMI
SDS, TG, HOMA-IR and APRI were positive predictors of NAFLD, with female sex being a negative
predictor. The accuracy of APRI as a biochemical marker of NAFLD was about 60%.In conclusion,
in a large (Italian) paediatric obese population, parameters, such as BMI SDS, TG, HOMA-IR and
APRI, were positive predictors of NAFLD, with female sex being a negative predictor and most of
the prediction explained by APRI. Nevertheless, APRI appears to be a simple biochemical marker of
liver injury rather than of NAFLD/NASH and, moreover, is endowed with a limited accuracy for the
prediction/diagnosis of NAFLD.