Diagnostic efficacy of noninvasive liver fibrosis indexes in predicting portal hypertension in patients with cirrhosis

Abstract

BackgroundRecent data suggest that noninvasive liver fibrosis indexes could be useful for predicting esophageal varices (EV) in cirrhotic patients. However, thus far, the diagnostic efficacy of these indexes in predicting portal hypertension (PH) in cirrhotic patients has been poorly evaluated.AimsTo evaluate the diagnostic efficacy of noninvasive liver fibrosis indexes in the diagnosis of PH.MethodsA total of 238 cirrhotic patients underwent hepatic venous pressure gradient (HVPG) evaluation and relevant serum tests to analyze the variables associated with PH grade. Then, the diagnostic performances of seven fibrosis indexes, the aspartate aminotransferase (AST)-to-alanine aminotransferase (ALT) ratio (AAR), AST-to-platelet (PLT) ratio index (APRI), fibrosis index (FI), FIB-4, Forns index, King’s score and the Lok index, were evaluated to determine their efficacy in predicting clinically significant PH (CSPH) and severe PH (SPH). In addition, the performances of these fibrosis indexes in different subgroups were investigated.ResultsThe results of a multivariate analysis of serum markers showed that AST values, platelet (PLT) count and albumin (ALB) were associated with PH grade. Among the seven—fibrosis indexes, King’s score, APRI and the Lok index showed modest diagnostic accuracy in predicting CSPH and SPH, as indicated by AUC of 0.755 and 0.742, 0.740 and 0.742, and 0.722 and 0.717, respectively. In addition, combination of King’s score (cutoff 23.47) and Lok index (cutoff 1.30) predicted presence of CSPH, with the highest PPV (95.38%) and +LR (5.49). A subgroup analysis indicated that the noninvasive screening model may be more applicable to patients with cirrhosis of viral etiology.ConclusionsSerum liver fibrosis indexes exhibited modest diagnostic accuracy for PH in cirrhotic patients. These indexes may not be able to replace HVPG measurements for the diagnosis of PH but may be used as a first-line screening method for CSPH in liver cirrhosis patients.

The diagnostic value of non-invasive serum liver fibrosis indices in the prediction of portal hypertension in cirrhotic patients: a cross-sectional study

“…But they concluded that since all studied indices had AUC<0.8, they could not be considered as accurate indices for prediction of portal hypertension. 7 In line with these results, we also showed that all indices had AUC ≤0.8 except the FORNS index. This may be due to this fact that all these indices were initially developed for the prediction of liver fibrosis in cirrhotic patients with hepatitis C. 12 However, we included cirrhotic patients with various etiology in the present study, intending to compare the mean score of different indices in patients with different etiology and disease severity.…”

Noninvasive Diagnostics for Portal Hypertension: A Comprehensive Review

“…Several studies investigated the use of simple liver fibrosis scores based on indirect liver fibrosis markers, such as fibrosis-4 (FIB-4), AST to platelet ratio Index (APRI), or Lok [79][80][81][82][83] as surrogates of portal hypertension. As expected, these markers showed some correlation with HVPG, in particular, if non-ACLD patients were included; however, none of these markers is sufficiently accurate to be of clinical value beyond the diagnosis of advanced liver fibrosis (i.e., ruling-out or ruling-in ACLD).…”

Noninvasive Evaluation of Liver Fibrosis and Portal Hypertension After Successful Portoenterostomy for Biliary Atresia

“…Similar liver stiffness cutoffs have been shown to predict clinically significant varices among patients with BA with normalized bilirubin . In addition, similar liver stiffness and APRI values correlate with PH defined by hepatic venous pressure gradient measurement, supporting the application of these cut‐off values into clinical practice . Overall, APRI was the best predictor of PH.…”