Predictive value of the aspartate aminotransferase to platelet ratio index and aspartate aminotransferase to alanine aminotransferase ratio in early diagnosis of intrahepatic cholestasis in pregnancy

Main Article Content

İbrahim Kale


Objective: We aimed to investigate the predictive value of the first-trimester aspartate aminotransferase/platelet count ratio index (APRI) and aspartate aminotransferase/alanine aminotransferase ratio for intrahepatic cholestasis in pregnancy (ICP).

Material and Methods: The clinical data of patients who admitted to the Obstetrics Department of Umraniye Training and Research Hospital, between 2015-2020 were analyzed retrospectively. The study group consisted of 44 patients with ICP and the control group consisted of randomly selected 92 healthy pregnant women.

Results: The two groups were similar in terms of age, BMI, first and third-trimester platelet count and third-trimester hemoglobin level. Patients with ICP had a significantly higher first-trimester APRI and a lower first trimester AST/ALT ratio than the healthy controls (p <0.001, p = 0.001, respectively). According to the ROC analysis, the optimal cut-off value of the APRI to predict ICP was 0.191, with the sensitivity of 0.66 and specificity of 0.66 (AUC: 0,727), and the optimal cut-off value for AST/ALT ratio was 1.07, with the sensitivity of 0.64, and specificity of 0.62 (AUC: 0,681).

Conclusion: The first-trimester APRI score and AST/ALT ratio is an easy, inexpensive, and non-invasive tool that may be useful in predicting ICP early.


Download data is not yet available.

Article Details

How to Cite
Kale, İbrahim. (2021). Predictive value of the aspartate aminotransferase to platelet ratio index and aspartate aminotransferase to alanine aminotransferase ratio in early diagnosis of intrahepatic cholestasis in pregnancy. Medical Science and Discovery, 8(11), 650–654.
Research Article
Received 2021-11-01
Accepted 2021-11-23
Published 2021-11-28


Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol. 2014 Jul;124(1):120–33.

Hwang JH, Chung ML. Predictive value of the aspartate aminotransferase to platelet ratio index for parenteral nutrition associated cholestasis in extremely low birth weight infants. BMC Pediatr. 2019 Apr 24;19(1):126.

Ünlüsoy Aksu A, Sarı S, Yılmaz G, Eğritaş Gürkan Ö, Demirtaş Z, Dalgıç B. Aspartate aminotransferase-to-platelet ratio index in children with cholestatic liver diseases to assess liver fibrosis. Turk J Pediatr. 2015 Oct;57(5):492–7.

D’Souza RS, Neves Souza L, Isted A, Fitzpatrick E, Vimalesvaran S, Cotoi C, et al. AST-to-platelet ratio index in non-invasive assessment of long-term graft fibrosis following pediatric liver transplantation. Pediatr Transplant. 2016 Mar;20(2):222–6.

Nyblom H, Björnsson E, Simrén M, Aldenborg F, Almer S, Olsson R. The AST/ALT ratio as an indicator of cirrhosis in patients with PBC. Liver Int Off J Int Assoc Study Liver. 2006 Sep;26(7):840–5.

Turhan U, Şahin B, Dağ İ. Lysyl oxidase like protein-2 (LOXL-2); a novel marker for prediction of intrahepatic cholestasis of pregnancy. J Matern Fetal Neonatal Med. 2021 Jul 18;34(14):2363–8.

Tayyar AT, Tayyar A, Atakul T, Yayla CA, Kilicci C, Eser A, et al. Could first- and second-trimester biochemical markers for Down syndrome have a role in predicting intrahepatic cholestasis of pregnancy? Arch Med Sci AMS. 2018 Jun;14(4):846–50.

Hançerlioğullari N, Aktulay A, Engin-Üstün Y, Ozkan MŞ, Oksuzoglu A, Danişman N. Pregnancy-associated plasma protein a levels are decreased in obstetric cholestasis. Clin Exp Obstet Gynecol. 2015;42(5):617–8.

Aksan Desteli G, Sahin-Uysal N, Cok T, Gulumser C, Kalayci H, Yanik FF. First trimester maternal serum PAPP-A levels and associated pregnancy complications in intrahepatic cholestasis of pregnancy. Clin Exp Obstet Gynecol. 2016;43(5):673–7.

Wai C-T, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatol Baltim Md. 2003 Aug;38(2):518–26.

Gonsalkorala ES, Cannon MD, Lim TY, Penna L, Willliamson C, Heneghan MA. Non-Invasive Markers (ALBI and APRI) Predict Pregnancy Outcomes in Women With Chronic Liver Disease. Am J Gastroenterol. 2019 Feb;114(2):267–75.

Şaşmaz Mİ, Ayvaz MA, Dülger AC, Kuday Kaykısız EK, Güven R. Aspartate-aminotransferase to platelet ratio index score for predicting HELLP syndrome. Am J Emerg Med. 2020 Mar;38(3):459–62.

Tolunay HE, Kahraman NÇ, Varlı EN, Ergani SY, Obut M, Çelen Ş, et al. First-trimester aspartate aminotransferase to platelet ratio index in predicting intrahepatic cholestasis in pregnancy and its relationship with bile acids: A pilot study. Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:114–7.

Huang C, Seah JJ, Tan CK, Kam JW, Tan J, Teo EK, et al. Modified AST to platelet ratio index improves APRI and better predicts advanced fibrosis and liver cirrhosis in patients with non-alcoholic fatty liver disease. Clin Res Hepatol Gastroenterol. 2020 Nov 29;101528.

Nyblom H, Berggren U, Balldin J, Olsson R. High AST/ALT ratio may indicate advanced alcoholic liver disease rather than heavy drinking. Alcohol Alcohol Oxf Oxfs. 2004 Aug;39(4):336–9.

Sheth SG, Flamm SL, Gordon FD, Chopra S. AST/ALT ratio predicts cirrhosis in patients with chronic hepatitis C virus infection. Am J Gastroenterol. 1998 Jan;93(1):44–8.

Nyblom H, Nordlinder H, Olsson R. High aspartate to alanine aminotransferase ratio is an indicator of cirrhosis and poor outcome in patients with primary sclerosing cholangitis. Liver Int Off J Int Assoc Study Liver. 2007 Jun;27(5):694–9.