Early identification of ICU patients with sepsis who are at risk of early death remains clinically important. The aspartate aminotransferase-to-platelet ratio index (APRI) is a simple laboratory-derived index, but its clinical value for very early mortality in adult ICU patients with sepsis remains insufficiently characterized. This study evaluated the association between admission APRI and short-term mortality in ICU patients with sepsis. This retrospective cohort study included 266 adults admitted to the ICU with sepsis. APRI was calculated from AST and platelet measurements obtained within 24 h of admission. Patients were categorized according to mortality timing. Associations with 7-day mortality were evaluated using logistic regression adjusted for age, sex, and comorbidity status. ROC and survival analyses were also performed. Of 266 patients, 32 died within 7 days, 88 between 8 and 28 days, and 72 after 28 days, and 74 survived. APRI was highest among patients who died within 7 days (median 1.919, IQR 0.631-5.009) compared with survivors (0.472, IQR 0.192-1.531; p = 0.0056). Higher log-transformed APRI remained associated with 7-day mortality after adjustment for age, sex, and comorbidity status (OR = 2.77, 95% CI 1.57-5.01; p = 0.0004). APRI showed modest discrimination for 7-day mortality (AUC = 0.687, 95% CI 0.580-0.793) and lower discrimination for 28-day mortality (AUC = 0.623, 95% CI 0.555-0.690). Elevated APRI was also associated with reduced short-term survival. Elevated admission APRI is independently associated with early mortality and reduced short-term survival in ICU patients with sepsis. However, its modest discrimination supports its use as an adjunct to established clinical risk assessment tools.

Serum-based fibrosis scores are widely used for noninvasive risk stratification in chronic liver disease; however, direct comparisons across liver disease etiologies remain limited, particularly in Asian populations with a high prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. This study retrospectively analyzed the data of adults who underwent transient elastography (FibroScan) at a university-affiliated hospital. Three fibrosis scores were evaluated: Fibrosis-4 index (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), and metabolic dysfunction-associated fibrosis-5 (MAF-5). Associations with advanced fibrosis (F3-F4) were examined using logistic regression. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC). Of the 2355 participants, the etiologic subgroups included metabolic dysfunction-associated steatotic liver disease (MASLD; n = 1070), HBV infection (n = 1459), and HCV infection (n = 250); 10.4% of the participants had advanced fibrosis (F3-F4). In the overall cohort, all scores were significantly associated with advanced fibrosis (p < 0.001) and demonstrated similar overall discrimination with AUROC in a range of 0.824-0.839. MAF-5 had the highest AUROC (0.839; 95% confidence interval [CI], 0.811-0.867) and greater risk classification compared with FIB-4 (net reclassification improvement = 0.168; 95% CI, 0.093-0.244). Subgroup analysis revealed that MAF-5 exhibited consistent discrimination across etiologies, with AUROCs of 0.822 (0.781-0.863) in MASLD, 0.843 (95% CI, 0.804-0.882) in HBV, and 0.810 (95% CI, 0.735-0.886) in HCV. Commonly used serum-based fibrosis scores exhibited comparable discrimination for advanced fibrosis. However, the metabolically informed MAF-5 score modestly improved risk classification across diverse liver disease etiologies.

We have previously developed a potential non-invasive fibrosis marker in the form of a lectin immunoassay for the detection of fucosylated α1-acid glycoprotein in plasma (P-AGP-FR). We aimed to investigate the diagnostic accuracy of P-AGP-FR for liver cirrhosis and fibrosis in a clinical setting of patients with chronic viral hepatitis. One hundred twenty-four patients, 80 with chronic hepatitis B and 44 with chronic hepatitis C, were recruited at two centers. P-AGP-FR levels were evaluated in relation to fibrosis or cirrhosis according to liver biopsy or transient elastography, and its diagnostic accuracy was compared with other noninvasive biochemical fibrosis markers; APRI and FIB-4. AGP fucosylation was elevated in patients with fibrosis, and the correlation of P-AGP-FR values with fibrosis levels was significant in all groups. The probability for fibrosis increased with higher P-AGP-FR values, with an odds ratio (OR) of 2.79. Receiver operating characteristic (ROC) curve analysis was done for the diagnostic accuracy of P-AGP-FR for fibrosis according to biopsy and liver elastography, respectively. Area under the ROC curve (AUROC) was 0.74 (95% CI: 0.58-0.91) for fibrosis according to biopsy and 0.72 (95% CI: 0.58-0.85) for fibrosis according to liver elastography. Optimal cutoff by Youden for fibrosis according to liver biopsy was 1.95, sensitivity 63.6% and specificity 85.7%. For fibrosis according to liver elastography, optimal cutoff was 1.44, sensitivity 54.6% and specificity 78.8%. In conclusion, AGP fucosylation measured as P-AGP-FR was significantly higher in patients with hepatic fibrosis and cirrhosis, and we found a significant correlation between P-AGP-FR and fibrosis stage.

Egyptian children undergoing chemotherapy are at high risk of hepatitis C virus (HCV) infection because of immunosuppression and multiple blood transfusions. This study evaluated liver fibrosis by comparing transient elastography with aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) in pediatric cancer survivors with chronic HCV infection. Fifty-one cancer survivors with chronic HCV infection (median age, 13.5 years) were prospectively recruited from the pediatric oncology and hepatology clinics at Ain Shams University and the National Cancer Institute. All participants underwent noninvasive fibrosis assessment using transient elastography, APRI, and FIB-4, as well as liver function testing, ultrasonography, and liver biopsy when necessary. Based on liver stiffness measurements, patients were classified into group 1 (fibrosis stage F0-F2; 80.4%) or group 2 (fibrosis stage F3-F4; 19.6%). Compared with group 1, group 2 had significantly higher serum bilirubin and alanine aminotransferase (ALT) levels, lower platelet counts, and higher APRI and FIB-4 scores (p<0.05). Liver stiffness was positively correlated with APRI, FIB-4, chemotherapy duration, ALT, ALP, and ferritin (p<0.05). The AUROCs of APRI and FIB-4 for predicting significant fibrosis (F3-F4) were 0.85 and 0.712, respectively. The cutoff values providing the best prediction of mild and severe fibrosis were 0.86 for APRI and 0.52 for FIB-4. APRI was more accurate than FIB-4 for detecting significant fibrosis. In conclusion, APRI and FIB-4 are useful noninvasive alternatives for assessing hepatic fibrosis in resource-limited countries, with APRI being preferable to FIB-4 for detecting significant fibrosis.

Background/Objectives: Polycystic ovary syndrome (PCOS) is closely associated with insulin resistance, metabolic syndrome (MetS), and non-alcoholic fatty liver disease (NAFLD); however, whether fatty pancreas disorder is also more common in PCOS remains insufficiently clarified. This study aimed to compare the frequency of hepatic and fatty pancreas disorder and tissue stiffness between women with PCOS and a healthy control group and to determine the relationship of these findings with metabolic and biochemical parameters. Methods: In this retrospective case-control study, 40 women diagnosed with PCOS according to the 2003 Rotterdam criteria and 40 age- and body mass index (BMI)-matched healthy women were evaluated by abdominal ultrasonography and two-dimensional shear wave elastography (2D-SWE) of the liver and pancreas. Four validated non-invasive indices of hepatic steatosis (NAFLD liver fat score, lipid accumulation product [LAP], hepatic steatosis index [HSI], FIB-4, APRI) were calculated and correlated with clinical, anthropometric, and biochemical data. MetS was defined according to International Diabetes Federation (IDF) criteria. Results: Fatty pancreas disorder was detected in 47.5% of PCOS patients versus 17.5% of controls (p = 0.008); hepatic steatosis was found in 37.5% and 15%, respectively (p = 0.04); these differences were observed despite similar age and BMI between groups. LAP and HSI scores were higher in the PCOS group (p = 0.02 and p = 0.005, respectively), as were serum triglyceride and total testosterone levels (p = 0.001 and p = 0.005, respectively). Overall MetS frequency did not differ between the PCOS and control groups (p = 0.61) but was significantly higher among participants with fatty pancreas disorder (p = 0.009) and hepatic steatosis (p = 0.05). Hepatic and pancreatic 2D-SWE values were significantly higher in participants with steatosis than in those without (p = 0.02 and p = 0.04, respectively), and both correlated positively with BMI (p < 0.001 and p = 0.003, respectively). Conclusions: The frequency of fatty pancreas disorder and hepatic steatosis is increased in women with PCOS independent of obesity, and both are associated with a higher frequency of MetS; the association between fatty pancreas disorder and PCOS remained significant in a multivariable analysis adjusted for BMI. Fatty pancreas disorder showed a stronger association with MetS, suggesting that it may serve as an early, low-cost, ultrasound-detectable marker of metabolic risk in PCOS and warrants systematic evaluation alongside hepatic steatosis.

This study was aimed to develop non-invasive liver fibrosis diagnostic model using chitinase 3-like protein 1 (CHI3L1) based on machine learning (ML).1,011 follow-up patients (556 training/455 validation) were enrolled, staging fibrosis via transient elastography (F01, F2, F23, F34, and F4). Demographic, clinical, and laboratory parameters were collected. Fibrosis-related indicators were selected by differential analysis and correlation analysis. ML models were developed, optimized, and validated. Of 23 initial laboratory indicators, 15 indicators were selected to developed a 5-stage liver fibrosis diagnostic model (XG-Boost, FIB5-15, area under the curve [AUC] = 0.93, sensitivity = 0.70, specificity = 0.93). This was refined to a 7-indicator model (FIB5-7, area under the ROC curve [AUC] = 0.98). By merging F2/F23 and F34/F4, a 3-category optimized model (FIB3-7, AUC = 0.94) and a 2-category model (FIB2-7, AUC = 0.95) were created to identify reversible fibrosis. The final FIB2-7 model significantly outperformed aspartate aminotransferase‑to‑platelet ratio index (APRI) and FIB-4 (p < 0.001). The CHI3L1-related liver fibrosis models are applicable across multiple clinical scenarios.