The diagnostic and prognostic value of APRI and de Ritis ratio in intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is associated with adverse perinatal outcomes. Accurate and timely diagnosis is essential to minimize maternal and fetal risks. The standard diagnostic method-measurement of fasting serum bile acids (BA)-poses challenges due to limited availability, high cost, and delayed results. This study aimed to evaluate the diagnostic and prognostic utility of the aspartate aminotransferase to platelet ratio index (APRI) and the De Ritis ratio in ICP.

This retrospective case-control study included 238 pregnant women, categorized into three groups: mild ICP (n = 62), severe ICP (n = 57), and healthy controls (n = 119). Demographic, biochemical, and perinatal outcomes were compared among the groups. APRI and De Ritis ratios were calculated and analyzed using receiver operating characteristic (ROC) curves and correlation analyses.

APRI levels were significantly elevated in ICP patients and demonstrated strong diagnostic performance for identifying ICP (cut-off: 0.295; AUC = 0.842). The De Ritis ratio was significantly lower in both ICP groups compared with controls (cut-off: 1.097; AUC = 0.770). APRI also correlated with disease severity (cut-off: 0.615 for severe ICP; AUC = 0.868). Higher APRI values were associated with increased neonatal intensive care unit (NICU) admissions and lower gestational age and birth weight.

APRI and De Ritis ratios are simple, inexpensive, and non-invasive markers that may aid in the diagnosis and severity assessment of ICP. They could serve as useful alternatives in clinical settings where BA testing is limited or unavailable.