Value of aMAP, APRI, FIB-4 and liver stiffness in predicting the degree of esophageal and gastric varices in patients with hepatitis B cirrhosis

Abstract

Abstract:

Objective:To explore the predictive value of age-male-ALBI-platelets (aMAP), aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis index based on the 4 factors (FIB-4) and liver stiffness measurement (LSM) on the degree of esophageal and gastric varices (EGV) in patients with hepatitis B cirrhosis.Methods:One hundred and fourteen patients with hepatitis B cirrhosis in Shanghai Ruijin Hospital from April 2018 to May 2022 were enrolled. Examinations including liver function, blood routine, LSM and gastroscopy were performed. aMAP, APRI, and FIB-4 were calculated using the calculation formulas of each model. Based on the results of gastroscopy, the patients were divided into four groups: non-EGV group (39 cases), mild EGV group (30 cases), moderate EGV group (23 cases) and severe EGV group (22 cases), and aMAP, APRI, FIB-4 between groups were compared. The receiver operator characteristic curve (ROC curve) was used to analyze the predictive value of aMAP, APRI, FIB-4 and LSM on the degree of EGV in patients with hepatitis B cirrhosis.Results:The aMAP, APRI, FIB-4 and LSM of patients with EGV groups (including mild, moderate and severe EGV groups) were significantly higher than those of the non-EGV group (P<0.05). The area under ROC (AUROC) of aMAP for evaluating the degree of EGV was 0.76, with sensitivity of 85.9% and specificity of 65.7%. The AUROC of APRI, FIB-4 and LSM for evaluating the degree of EGV were 0.86, 0.85 and 0.79 respectively, and the sensitivities were 81.30%, 82.80% and 88.40% respectively, and the specificities were 82.90%, 77.10% and 66.80% respectively. aMAP, APRI, FIB-4 and LSM have a good predictive value for EGV in patients with liver cirrhosis (P<0.05). Compared with the aMAP, APRI, FIB-4 and LSM in patients with mild, EGV, the aMAP, APRI and FIB-4 of patients with moderate and severe of EGV were significantly different (P<0.05). There was a significant difference in LSM between mild EGV group and moderate-severe group (P<0.05). aMAP, APRI and FIB-4 have certain predictive values for the degree of EGV in hepatitis B cirrhosis patients (P<0.05), with decreased sensitivi-ty and specificity.Conclusions：aMAP, APRI, FIB-4 and LSM are of high predictive value for the presence of EGV in patients with hepatitis B cirrhosis. aMAP, APRI and FIB-4 have certain predictive values for the degree of EGV and can be used as a supplementary method for the evaluation of EGV by invasive gastroscopy, and can provide the basis for the prevention and treatment of EGV.

Key words:Esophageal and gastric varices,Age-male-albi-platelets,Aspartate aminotransferase-to-platelet ratio index,Fibrosis index based on the 4 factors,Liver stiffness measurement

CLC Number:

R571.3

AN Baoyan, GUO Qing, FENG Mingyang, XU Yumin, CAI Wei, XIE Qing, WANG Hui. Value of aMAP, APRI, FIB-4 and liver stiffness in predicting the degree of esophageal and gastric varices in patients with hepatitis B cirrhosis[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(02): 141-146.

Figures/Tables6

Indice	non-EGV	EGV	t	P
ALT（IU/L）	25.57±7.18	27.93±8.71	1.52	0.15
AST（IU/L）	30.79±6.32	38.17±11.20	1.38	0.18
AKP（IU/L）	97.25±37.00	101.89±44.39	1.73	0.10
γ-GT（IU/L）	31.86±20.08	34.82±21.85	2.11	0.08
PLT（×10⁹L）	135±67	56±46	5.89	0.01
aMAP	53.83±6.79	62.52±7.36	4.91	<0.01
APRI	0.57±0.37	1.77±0.69	6.04	<0.01
FIB-4	2.21±1.07	5.66±3.09	5.40	<0.01
LSM(kPa)	10.44±3.72	17.62±7.43	3.86	<0.01

Table 1

Indice	Mild EGV group	Moderate EGV group	Severe EGV group
aMAP	55.91±4.74	63.64±8.16	68.50±5.34
LSM	13.38±5.21	19.04±7.56	20.01±7.46
APRI	1.15±0.62	1.82±0.87	2.62±0.60
FIB-4	4.47±2.86	5.86±4.32	6.74±1.93

Table 2

Indice	AUROC	95%CI	Sensitivity（%）	Specificigy（%）	P
aMAP	0.76	0.66-0.87	85.90	65.70	<0.01
APRI	0.86	0.77-0.94	81.30	82.90	<0.01
FIB	0.85	0.77-0.94	82.80	77.10	<0.01
LSM(KPa)	0.79	0.70-0.88	88.40	66.80	<0.01

Table 3

Figure 1

Indice	AUROC	95%CI	Sensitivity（%）	Specificigy（%）	P
aMAP	0.64	0.52-0.74	90.20	48.30	0.02
APRI	0.72	0.62-0.82	82.90	58.60	<0.01
FIB-4	0.74	0.64-0.84	78.00	62.10	<0.01
LSM(kPa)	0.56	0.44-0.67	97.60	27.00	0.31

Table 4

Figure 2

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