Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) as a Novel Score in Early Detection of Complicated Dengue Fever

Figures & data

Table 1 Table Showing the Comparison of Laboratory Parameters, Radiological Findings and Clinical Outcome Among Three Stages (Dengue Fever, Dengue Hemorrhagic Fever and Dengue Shock Syndrome) of Dengue Patients. Mean, Standard Deviation, Percentages and p value are Used for Expression of Variables

Variables	Uncomplicated Dengue infection	Complicated Dengue infection
	Dengue fever (n=82)	DHF* (n=34)	DSS^† (n=19)	P value
Age (years)	43.64 ± 21.42	38.62 ± 18.32	37.15 ± 16.44	0.36
Hemoglobin (g/dl)	13.34 ± 3.19	12.88 ± 1.87	12.73 ± 3.25	0.65
WCC^‡ x 10^3 cells/L	7.78 ± 5.28	2.77 ± 1.24	1.92 ± 0.66	0.03
HcT	35.88 ± 7.31	49.01 ± 1.24	51.06 ± 5.16	0.01
Platelets x 10^3 cells/L	109.41 ± 78.95	42.00 ± 23.71	24.18 ± 15.62	0.001
Bilirubin (μmol/L)	8.95 ± 2.34	9.34 ± 5.23	10.59 ± 6.09	0.91
AST^§ (IU/L)	94.32 ± 50.85	198.15 ± 58.00	295.00 ± 39.35	0.000
Albumin (g/L)	36.40 ± 8.92	33.00 ± 6.21	32.67 ± 8.83	0.53
Urea (mmol/L)	4.45 ± 1.58	6.26 ± 4.36	11.52 ± 2.75	0.02
Creatinine (μmol/L)	72.92 ± 29.64	81.63 ± 29.26	86.94 ± 47.13	0.30
Previous dengue infection	4.9% (4/82)	76.5% (26/34)	84.2% (16/19)	0.00
Ultra sonographic Findings
Gall bladder wall thickness	0% (0/82)	97.1% (33/34)	100% (19/19)	0.00
Ascites	0% (0/82)	76.5% (26/34)	100% (19/19)	0.00
Pleural effusion	0% (0/82)	61.8% (21/34)	73.7% (14/19)	0.00
Clinical outcome
Hospital stay (days)	2.12 ± 1.50	3.80 ± 1.26	5.40 ± 4.27	0.00
Survived	100% (82/82)	97.1% (33/34)	78.9% (15/19)	0.00
Died	0% (0/82)	2.9% (1/34)	21.1% (4/19)

Notes: The significant p values are highlighted bold.

Abbreviations: *DHF, Dengue hemorrhagic fever; ^†DSS, Dengue Shock Syndrome; ^‡WCC White cell count; ^§AST, Aspartate Aminotransferase.

Figure 1 The ROC curve showing the area under the curve (AUC) of APRI score in predicting the disease complication. AUC=0.93 showing it is an excellent marker in predicting the dengue complications (p<0.001).

Table 2 Table Showing the Area Under the Curve for APRI Score and the Sensitivity, Specificity, Positive and Negative Likelihood Ratios of Its Cut-off Value

	AUC*	Cut off value	Sen. ^§	95% CI	Sp.^#	95% CI	+LR^†	95% CI	-LR^‡	95% CI	P value
APRI score	0.93	≥9.04	84.91%	72.4–93.3	89.02%	80.2–94.9	7.74	4.13–14.48	0.17	0.09–0.32	<0.0001

Abbreviations: *AUC, Area under the curve; ^†+LR, positive likelihood ratio; ^‡-LR, negative likelihood ratio; ^§Sen, Sensitivity; ^#Sp, Specificity.

Table 3 Table Showing the Comparison of Occurrence of Three Stages of Dengue Infection, Survival and Mortality Percentages Among the Two Groups Divided by Cut-off Value. Patients with APRI <9.04 and Patients with APRI >9.04

Variables	APRI* <9.04 (n=81)	APRI* >9.04 (n=54)	P value
Dengue fever	54.1% (73/135)	6.7% (9/135)	0.00
DHF^†	4.4% (6/135)	20.7% (28/135)	0.00
DSS^‡	1.5% (2/135)	12.6% (17/135)	0.00
Survived	60% (81/135)	36.3% (49/135)	0.00
Non survived	0	3.7% (5/135)

Notes: The significant p values are highlighted bold.

Abbreviations: *APRI Aspartate Aminotransferase to Platelet ratio index; ^†DHFDengue Hemorrhagic Fever; ^‡DSS Dengue Shock Syndrome.

Table 4 Cox Regression Analysis Showing Statistically Significant Variables in Predicting the Severity of Dengue Infection Among the Study Cohort

Variables	OR* (95% CI^†)	P value
Bleeding from any site of body	0.07 (0.01–0.17)	0.00
Right hypochondrial tenderness	0.39 (0.19–0.97)	0.03
Previous symptomatic dengue infection	0.18 (0.03–0.85)	0.04
Platelets x 10^3 cells/L	1.05 (1.03–1.07)	0.00
AST^‡ (IU/L)	0.96 (0.95–0.97)	0.00
Ascites	0.32 (0.08–0.74)	0.04
APRI category	0.37 (0.30–0.47)	0.00
APRI score	0.75 (0.68–0.83)	0.00

Abbreviations: *OR, Odd Ratio; ^†CI, Confidence Interval; ^‡AST, Aspartate Aminotransferase.