APRI, FIB-4, and FIB-5 Scores and Their Association with Late-Onset Preeclampsia

Abstract

OBJECTIVES: Late-onset preeclampsia (LO-PE) is a major cause of maternal–perinatal morbidity. Noninvasive liver fibrosis indices, the AST-to-platelet ratio index (APRI), Fibrosis-4 (FIB-4), and Fibrosis-5 (FIB-5), may capture subclinical hepatic injury in preeclampsia. We assessed the association of these indices with LO-PE and their diagnostic performance.

STUDY DESIGN; In this single-center, retrospective, case-control study, we compared pregnant women with LO-PE (defined as preeclampsia onset at or after 34 weeks of gestation, with no chronic hypertension; n=84) with healthy pregnant controls matched by gestational age (n=84). Demographics, obstetric features, and laboratory parameters (AST, ALT, ALP, platelet count, and albumin) were obtained from medical records. APRI, FIB-4, and FIB-5 indices were calculated using standard formulas. Differences between groups were assessed using statistical tests. For normally distributed data, parametric tests (such as the independent-samples t-test) were used. For nonnormally distributed data, we used nonparametric tests (such as the Mann-Whitney U test). The ability of each index to distinguish between cases and controls was evaluated using ROC curve analysis. ROC analysis plots sensitivity versus 1-specificity to assess diagnostic performance.

RESULTS: ALT, AST, ALP, FIB-4, and APRI levels were significantly higher, whereas FIB-5, platelet, and albumin levels were significantly lower in patients with preeclampsia than in controls (p<0.05). APRI, FIB-4, and FIB-5 values were found to be important parameters affecting disease status (p<0.05). When APRI and FIB-4 values increase by 1 unit, the risk of disease will increase 23.683 and 59.402 times, respectively. In contrast, for each additional unit increase in the FIB-5 score, the risk of disease decreases by 13.3%.

CONCLUSION: APRI and FIB-4 are independent predictors of LO-PE and provide robust discrimination between affected and unaffected patients. While FIB-5 offers limited diagnostic accuracy, APRI and FIB-4, available from routine antenatal labs, can be leveraged for timely risk stratification and early detection of LO-PE. However, prospective validation and clear thresholds are needed to enable effective clinical implementation.