An Exploration of Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST) Platelet Ratio Index (APRI) Scores with Dysglycemia and Diabetic Retinopathy: The Beichen Eye Study

Limei Chen, Xiaoxia Miao, Manqiao Wang, Fei Gao, Emmanuel Eric Pazo, Liying Hu, Chen Chen, Yu Shi, Xiuqing Zhu, Xiaorong Li, Juping Liu Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of ChinaCorrespondence: Juping Liu, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China, Email [email protected] Xiaorong Li, Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, People’s Republic of China, Email [email protected] and Purpose: Liver metabolism is closely linked to glucose levels. Studies have shown that the aspartate aminotransferase to platelet ratio index (APRI), as a marker of liver fibrosis, is associated with type 2 diabetes mellitus (T2DM). However, the existing evidence remains insufficient to establish this association definitively. Furthermore, no prior studies have investigated the potential relationship between APRI and diabetic retinopathy (DR). This study aimed to investigate the association of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) to platelet ratio index (APRI) scores with dysglycemia and DR.Methods: This cross-sectional study analyzed data from 5828 participants aged 50 and older. All participants underwent laboratory blood tests, ophthalmological examinations, and interviews using questionnaires. Multiple linear regression models and receiver operating characteristic (ROC) curves explored the association between ALT and AST APRI scores and dysglycemia. Binary logistic regression was used to analyze the association between ALT and AST APRI scores and DR. Analyses were conducted for males and females separately to examine sex-specific effects.Results: In the multiple linear regression models, ALT and AST APRI scores were associated with fasting blood glucose after adjusting various potential confounders in the whole population or subgroup analysis (all P < 0.05). ALT APRI score was superior to AST APRI score in the discrimination of hyperglycemic participants. In the univariate analysis, the ALT and AST APRI scores were associated with DR in the female participants with diabetes (P = 0.043, P=0.022). However, binary logistic regression models found no evident significant association between the ALT and AST APRI scores and DR in the female participants with diabetes (all P> 0.05).Conclusion: ALT and AST APRI scores are potential markers for the diagnosis of hyperglycemia, and ALT APRI score is superior to AST APRI score. ALT and AST APRI scores are not independent risk factors for DR.Keywords: APRI score, alanine aminotransferase, aspartate aminotransferase, dysglycemia, diabetic retinopathy