Association between FAR, PAR, APRI and adverse neonatal outcomes in pregnancies complicated by intrahepatic cholestasis.

Abstract

Objectives: This study aimed to evaluate the predictive value of inflammatory biomarkers fibrinogen/albumin ratio (FAR), platelet/albumin ratio (PAR), and AST/platelet ratio (APRI) in identifying poor neonatal outcomes among pregnancies complicated by IHCP.

Methods: This retrospective comparative study included 165 pregnant women diagnosed with IHCP and 155 healthy pregnant women matched for age and gestational age, who delivered at a tertiary care hospital between January 2023 and January 2025. Demographic, clinical, laboratory, and perinatal characteristics were reviewed. FAR, PAR, and APRI were calculated from standard laboratory data. A composite poor neonatal outcome was defined as the presence of at least one of the following: Apgar score <7 at 5 min, respiratory distress syndrome (RDS), meconium aspiration, neonatal sepsis, or admission to the neonatal intensive care unit (NICU). Diagnostic performance was assessed using receiver operating characteristic (ROC) curves and multivariate logistic regression.

Results: FAR and APRI values were significantly higher in the IHCP group compared to controls (p<0.05). Among neonates with adverse outcomes, only FAR levels were significantly elevated (p = 0.015). However, its discriminative ability was limited (AUC = 0.607; sensitivity: 58 %, specificity: 63 %) and it was not an independent predictor in multivariate analysis.

Conclusions: FAR and APRI levels are elevated in pregnancies with IHCP, yet FAR alone demonstrates limited predictive value for adverse neonatal outcomes. It may serve as a supportive, rather than standalone, marker. Further large-scale prospective studies are warranted.