Distinct associations of APRI and creatinine-based ratios with disease severity and adverse perinatal outcomes in preeclampsia.

@article{yalcin2026distinct,
  title = {{Distinct associations of APRI and creatinine-based ratios with disease severity and adverse perinatal outcomes in preeclampsia.}},
  author = {Serenat Eris Yalcin and Zeliha Atak},
  journal = {BMC pregnancy and childbirth},
  year = {2026},
  month = aug,
  doi = {10.1186/s12884-026-09749-z},
  url = {https://europepmc.org/article/MED/42958121},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - Distinct associations of APRI and creatinine-based ratios with disease severity and adverse perinatal outcomes in preeclampsia.
AU  - Serenat Eris Yalcin
AU  - Zeliha Atak
PY  - 2026
DA  - 2026/08/01
JO  - BMC pregnancy and childbirth
DO  - 10.1186/s12884-026-09749-z
UR  - https://europepmc.org/article/MED/42958121
AB  - Objective  To evaluate the discriminatory performance and clinical associations of the aspartate aminotransferase-to-platelet ratio index (APRI), uric acid-to-creatinine (UA/Cr) ratio, and creatinine-to-fibrinogen ratio beyond clinical variables for assessment of disease severity and adverse perinatal outcomes in pregnancies complicated by preeclampsia.Methods  This retrospective cohort study included 220 singleton pregnancies diagnosed with preeclampsia at a tertiary referral center. Biomarkers were calculated using laboratory parameters obtained at the time of diagnosis and evaluated in relation to disease severity at presentation and adverse perinatal outcomes. A base clinical model including maternal age, body mass index, gestational age at diagnosis, and systolic blood pressure was constructed. Discriminatory performance was assessed using receiver operating characteristic (ROC) curve analysis and changes in the area under the curve (AUC). Multivariable logistic regression analyses were performed for preeclampsia with severe features and adverse neonatal outcomes.Results  Preeclampsia with severe features occurred in 25.5% of patients. The creatinine-to-fibrinogen ratio demonstrated the highest discriminatory performance for distinguishing preeclampsia with severe features from preeclampsia without severe features (AUC = 0.923), followed by UA/Cr (AUC = 0.840) and APRI (AUC = 0.688). The clinical model yielded an AUC of 0.772, which increased to 0.876 with the addition of UA/Cr and to 0.942 with the inclusion of the creatinine-to-fibrinogen ratio, whereas APRI provided minimal additional discriminatory value (AUC = 0.782). In adjusted multivariable analyses, both UA/Cr (OR = 1.75, 95% CI: 1.45-2.11, p < 0.001) and the creatinine-to-fibrinogen ratio (OR = 6.92, 95% CI: 3.55-13.51, p < 0.001) remained independently associated with preeclampsia with severe features. APRI was independently associated with very low birth weight and composite adverse perinatal outcome.Conclusion  Creatinine-based composite ratios were significantly associated with the presence of severe features and provided additional discriminatory information beyond clinical variables. Both UA/Cr and the creatinine-to-fibrinogen ratio remained independently associated with maternal disease severity after adjustment for clinical factors, whereas APRI was more closely associated with fetal growth-related adverse outcomes. These laboratory-derived indices may provide complementary information for severity assessment in pregnancies complicated by preeclampsia.
SN  - 1471-2393
ER  -