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SUMMARY OBJECTIVE: Autoimmune hepatitis is a rare inflammatory disease of the liver that is characterized by elevated liver enzymes. The hemoglobin, albumin, lymphocyte, and platelet score, which is derived from hemoglobin, serum albumin, circulating lymphocyte count, and platelet count, is also associated with inflammatory conditions. The aim was to examine the hemoglobin, albumin, lymphocyte, and platelet score of patients with autoimmune hepatitis and to compare it to that of healthy individuals in this retrospective analysis. METHODS: Subjects diagnosed with autoimmune hepatitis were enrolled in the study, and healthy individuals were enrolled as controls. Moreover, autoimmune hepatitis subjects were grouped into mild or moderate/advanced fibrosis. Furthermore, aspartate to platelet ratio index, Fibrosis-4, and hemoglobin, albumin, lymphocyte, and platelet scores of the autoimmune hepatitis patients and controls were compared. In addition, the hemoglobin, albumin, lymphocyte, and platelet score of the autoimmune hepatitis patients with mild fibrosis is compared to that of those with moderate/advanced fibrosis. RESULTS: The mean hemoglobin, albumin, lymphocyte, and platelet score of the autoimmune hepatitis patients was 44.2±14.5 while this value was 76.8±15.5 in control subjects. The hemoglobin, albumin, lymphocyte, and platelet score was significantly reduced in autoimmune hepatitis patients than healthy controls (p<0.001). The hemoglobin, albumin, lymphocyte, and platelet score was significantly and negatively correlated with C-reactive protein, aspartate, alanine transaminase, gamma glutamyl transferase, aspartate to platelet ratio index, and Fibrosis-4 values. A hemoglobin, albumin, lymphocyte, and platelet score that was lower than 52.3 had 83% sensitivity and 73% specificity in predicting autoimmune hepatitis. The sensitivity and specificity of the hemoglobin, albumin, lymphocyte, and platelet score were higher than the Fibrosis-4 score in predicting moderate/advanced fibrosis in autoimmune hepatitis. CONCLUSION: We suggest that the hemoglobin, albumin, lymphocyte, and platelet score be used as an additional noninvasive diagnostic tool for autoimmune hepatitis and to predict moderate/advanced liver fibrosis in patients with autoimmune hepatitis.
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Objectives@#This study aimed to compare the severity of COVID-19, inflammatory parameters and clinical outcomes among patients with normal and subnormal levels of Vitamin D.@*Methodology@# This is a retrospective cohort study of 135 patients admitted in a tertiary hospital for COVID-19. Patients were grouped according to their Vitamin D level. Primary outcome measure was the composite of all-cause mortality and morbidity. Other outcome measures determined were the comparison among the groups on the severity of COVID-19 infection, changes in inflammatory parameters, length of hospital stay and duration of respiratory support.@*Results@#There was a significant trend of higher ICU admission, mortality (p-value= 0.006) and poor clinical outcome (p-value=0.009) among the Vitamin D deficient group. No significant difference was found for most of the inflammatory parameters, duration of hospital stay and respiratory support. Overall, patients with deficient, but not insufficient Vitamin D level had 6 times higher odds of composite poor outcome than those with normal Vitamin D (crude OR=5.18, p-value= 0.003; adjusted OR =6.3, p-value=0.043).@*Conclusion@#The inverse relationship between Vitamin D level and poor composite outcome observed in our study suggests that low Vitamin D may be a risk factor for poor prognosis among patients admitted for COVID-19.
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Diabetes Mellitus Tipo 2 , Enfermedad del Hígado Graso no AlcohólicoRESUMEN
Aims: Non-alcoholic fatty liver disease (NAFLD) is a broad category for a disease spectrum that includes simple steatosis, which can proceed to non-alcoholic steatohepatitis, cirrhosis, and, finally, hepatocellular carcinoma. Owing to the invasive nature of liver biopsy, the need for non-invasive tools were required for diagnosis. Objective: To compare the performance of simple biochemical scores (fibroblast) FIB-5 and (fibrosis-4) FIB-4 with fibroscan to differentiate mild to moderate fibrosis (MF; F0 to F2) from advanced fibrosis (AF; F3 to F4) in patients with NAFLD. Patients and methods: This cross-sectional study was done on 116 NAFLD patients. All patients were scanned with the FibroScan examination. FIB-5 and FIB-4 were calculated for all patients. Results: The mean kPa score (liver stiffness measurement score) of the patients belonging to advanced fibrosis [9.53 ± 1.05]. The FIB-4 score was significantly higher in patients with advanced fibrosis (1.54 ± 0.38) compared with patients with mild to moderate fibrosis (1.18 ± 0.44), p-value = 0.001, whereas the FIB-5 score was insignificant between patients. Conclusion: FIB-4 is superior to FIB-5 as a non-invasive simple marker in diagnosing advanced fibrosis in NAFLD patients.
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Enfermedad del Hígado Graso no AlcohólicoRESUMEN
Objective To investigate the influence of vitamin D deficiency on nonalcoholic steatohepatitis (NASH). Methods The patients with NASH who were hospitalized in Department of Infectious Diseases, The First Hospital of Changsha, from January 2020 to October 2021 were enrolled, and according to the serum level of 1, 25(OH) 2 D 3 , they were divided into group A with 1, 25(OH) 2 D 3 deficiency ( 30 ng/mL). The three groups were compared in terms of the serum levels of 1, 25(OH) 2 D 3 , alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), total cholesterol (TC), triglyceride (TG), interleukin-18 (IL-18), and interleukin-37 (IL-37) and liver pathological grade, and fibrosis-4 (FIB-4) index was calculated. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t -test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups. A Pearson correlation analysis was also performed. Results A total of 120 NASH patients were enrolled, with 40 patients in each group. Compared with group A, groups B and C had significant increases in the levels of 1, 25(OH) 2 D 3 and IL-37 and significant reductions in FIB-4 index and the levels of ALT, AST, TBil, TC, TG, and IL-18 (all P < 0.05). Compared with group B, group C had significant increases in the levels of 1, 25(OH) 2 D 3 and IL-37 and significant reductions in FIB-4 index and the levels of ALT, AST, TC, TG, and IL-18 (all P < 0.05). The correlation analysis showed that 1, 25(OH) 2 D 3 was negatively correlated with ALT ( r =-0.84, P < 0.001), AST ( r =-0.77, P < 0.001), TBil ( r =-0.32, P < 0.001), TC ( r =-0.45, P < 0.001), TG ( r =-0.42, P < 0.001), IL-18 ( r =-0.40, P < 0.001), and FIB-4 index ( r =-0.62, P < 0.001), and it was positively correlated with IL-37 ( r =0.59, P < 0.001). Compared with group A, groups B and C had significant reductions in the proportion of patients with severe steatosis ( χ 2 =51.46, P < 0.001), bridging fibrosis and early liver cirrhosis ( χ 2 =36.59, P < 0.001), or bridging necrosis and large-scale necrosis ( χ 2 =37.28, P < 0.001). Light microscopy showed that group A had extensive ballooning degeneration of hepatocytes, a large number of lipid droplets (mainly macrovesicular lipid droplets), disordered arrangement of the liver plate, lymphocyte infiltration, and focal bridging fibrosis; group B mainly had spotted focal necrosis, periportal fibrosis, lipid droplets with various sizes, a small amount of neutrophil infiltration, and ballooning degeneration of some hepatocytes; group C had ballooning degeneration of a small number of hepatocytes, focal perisinusoidal fibrosis, a small number of lesions with spotted focal necrosis, and a small number of lipid droplets in the cytoplasm of hepatocytes. Conclusion The degree of liver injury and fibrosis increases with the reduction in vitamin D level, and vitamin D measurement helps to evaluate the progression of NASH.
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Background: Acute-on-chronic liver failure (ACLF) is a rapid-developing critical illness with a high mortality. Accurate prediction of the prognosis of patients with ACLF can guide the individualized therapy, and effectively and rationally utilize the scarce liver source. Aims: To investigate the short-term prognostic value of ALBI, NLR, FIB-4, and MELD score in ACLF patients undergoing plasma exchange (PE). Methods: A retrospective analysis was conducted on clinical data of consecutive patients with ACLF undergoing PE from Jan. 2015 to Jul. 2019 at the Nantong Third People's Hospital. According to the survival status at 3 months after admission, the eligible cases were allocated into improvement group and deterioration group (including clinical deterioration, liver transplantation and death cases). The laboratory parameters before PE were recorded to calculate the score of ALBI, NLR, FIB-4, and MELD. Multivariate logistic regression analysis was performed to identify the influencing factors for prognosis and a combined prognostic model was constructed. ROC curve was used to assess the performance of single and combined score for predicting the short-term prognosis. Results: A total of 147 ACLF patients were enrolled, 71 in improvement group and 76 in deterioration group. ALBI, NLR, FIB-4, and MELD score were all significantly increased in deterioration group than in improvement group (P<0.05). Multivariate logistic regression analysis revealed that all four single score were independent risk factor for poor short-term prognosis of ACLF patients undergoing PE. Area under the ROC curve (AUC) was 0.767, 0.884, 0.750 and 0.860 for ALBI, NLR, FIB-4, and MELD, respectively. When using triple (ALBI+NLR+FIB-4) or quadruple (ALBI+NLR+FIB-4+MELD) combined score established by logistic regression model, AUC could increase to 0.918 and 0.946, respectively. Conclusions: ALBI, NLR, FIB-4, MELD score has a good value for evaluating the short-term prognosis of ACLF patients undergoing PE. Combined model including these four single score has higher predictive value.
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Objective To assess the diagnostic performance of liver stiffness measurement(LSM)and serum markers on hepatic fibrosis in chronic hepatitis B(CHB)patients with alanine aminotransferase(ALT)less than or equal to two times the upper limit of normal(≤2×ULN).Methods A total of 284 CHB patients with ALT≤2×ULN who were treated in Department of Hepatobiliary Medicine,Public Health Clinical Center,Shanghai from October 2015 to December 2017 were analyzed.FibroScan,routine blood tests and serum fibrosis markers were conducted on the day or one day before liver biopsy.The Scheuer scoring system was used for liver histologic assessment.Aspartate aminotransferase to platelet ration index(APRI)and FIB-4 were calculated.Based on the results of liver pathology,the area under receiver operating characteristic curve(AUROC)was used to evaluate the value of LSM and serum markers in the diagnosis of liver fibrosis stage.Non-normal distribution variables were expressed as M(QR)as appropriate,and compared by analysis of Kruskal-Wallis test as appropriate.The correlation between two variables was analyzed by Spearman correlation analysis.Results Of 284 CHB patients,175 were male and 109 were female.For inflammatory grading,175 cases were G1 grade,88 cases were G2,and 21 cases were G3.For fibrosis grading,153 cases were S1,53 cases were S2,34 cases were S3,and 44 cases were S4.Spearman correlation analysis showed that LSM,APRI and FIB-4 were positively correlated with hepatic fibrosis stage(r=0.650,0.484,and 0.317,respectively,all P<0.01).The AUC of LSM for predicting fibrosis≥S2,≥S3,and S4 were 0.840,0.902,and 0.942,respectively.The cut-off of LSM values were 6.10,8.40,and 10.10 kPa,respectively.The values of AUC of APRI and FIB-4 for predicting fibrosis≥S2 were 0.755 and 0.638,respectively,those for predicting fibrosis≥S3 were 0.737 and 0.657,respectively,and those for S4 were 0.804 and 0.694,respectively.The AUCs of LSM for predicting fibrosis≥S2 in patients with ALT≤1×ULN and those with ALT>1 -≤2×ULN were 0.857 and 0.813,respectively,those for fibrosis≥S3 were 0.890 and 0.892,respectively,and those for S4 were 0.925 and 0.908,respectively.The cut-off of LSM were 5.90 and 7.80 kPa,8.10 and 9.50 kPa,8.40 and 10.40 kPa,respectively.Conclusions LSM could accurately assess the degree of liver fibrosis in CHB patients with ALT≤2×ULN,which is superior to serum markers for predicting liver fibrosis stage.
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OBJECTIVE: We intended to evaluate the diagnostic efficiency of red cell distribution width to platelet ratio(RPR),and compare it with other three markers of fibrosis-4(FIB-4), aspartate aminotransferase-to-platelet-ratio-index(APRI) and aspartateaminotransferase-to-alanine aminotransferase ratio(AAR) for judging liver fibrosis and fibrosis severity in patients with chronic hepatitis B(CHB). METHODS: who had not received antiviral treatment met the requirements of this cross-sectional study. Hematology,biochemistry, virology testing and liver biopsy were performed. Receiver-operating characteristic curves were constructed and the area under the ROC curve was calculated. RESULTS: The cut-off value for distinguishing F0-1, F2-3 and F4 was 0.079, 0.141 and 0.279,respectively(P<0.001) for RPR; 1.194, 3.703 and 4.383(P<0.001) for FIB-4; 0.384, 0.660 and 1.441, respectively(P<0.001) for APRI; and 0.915, 0.850 and 0.960(P=0.706) for AAR. The sensitivity was 76.09% for RPR, 78.26% for FIB-4, 97.83% for AAR and80.43% for APRI; specificity was 81.48% for RPR, 75.93% for FIB-4, 14.81% for AAR and 80.43% for APRI; the AUROC was 0.787 for RPR, 0.778 for FIB-4, 0.540 for AAR and 0.759 for APRI. The common cut-off value was 0.11, 1.94, 0.60 and 0.59 for RPR, FIB-4, AAR and APRI respectively. CONCLUSION: RPR, FIB-4 and APRI have good efficiency in appraising significant and severe fibrosis in patients with CHB, however RPR is superior to FIB-4 and FIB-4 is superior to APRI, therefore, RPR is a better index in evaluating liver cirrhosis.
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Objective@#To compare the diagnostic efficacy of transient elastography (TE) FibroScan and acoustic radiation force impulse imaging (ARFI) combined with serological models including aspartate aminotransferase-to-platelet ratio (APRI) and fibrosis-4 (FIB-4) in hepatitis B virus-related fibrosis.@*Methods@#Sixty-seven patients with chronic HBV infection from October 2014 to May 2017 in Department of Infectious Diseases, Putuo Hospital were enrolled. Both FibroScan and ARFI were conducted in all patients together with serological tests. According to the golden standard of pathology results, the diagnosis values of FibroScan, ARFI combined with APRI or FIB-4 were compared as noninvasive assessment for liver fibrosis. Data with homogeneity of variance were tested by t test, and data with heterogeneity of variance were tested by Mann-Whitney U test.@*Results@#Based on the pathology results, the receiver operating characteristic (ROC) areas under the curve (AUC) of APRI, FIB-4, FibroScan and ARFI in diagnosis of hepatic fibrosis ≥S2 were 0.752, 0.612, 0.885, and 0.850, respectively. The AUC of ROC curve in diagnosis of hepatic fibrosis ≥S3 were 0.746, 0.733, 0.851, and 0.863, respectively. The AUC of ROC curve in diagnosis of hepatic fibrosis ≥S4 were 0.782, 0.705, 0.962 and 0.981, respectively. Combined liver imaging technique and serological tests, such as APRI with FibroScan, APRI with ARFI, FIB-4 with FibroScan or FIB-4 with ARFI, the AUC of ROC curve in the 4 groups in diagnosis of hepatic fibrosis ≥S2 were 0.887, 0.861, 0.893, and 0.853, respectively; in the diagnosis of hepatic fibrosis ≥S3 were 0.873, 0.871, 0.900, and 0.875, respectively; and in diagnosis of hepatic fibrosis ≥S4 were 0.952, 0.981, 0.969, and 0.981, respectively. FibroScan and ARFI were positively correlated with liver inflammation (r=0.467, P=0.000; r=0.371, P=0.002) and jaundice (r=0.424, P=0.000; r=0.0.312, P=0.01), while negatively correlated with platelet (r=-0.331, P=0.006; r=-0.312, P=0.01). The AUC of ROC curve of FibroScan, ARFI and their combination with serological model were significantly increased compared with the single serological model (all P<0.05).@*Conclusions@#Serological models such as APRI and FIB-4 as well as liver imaging techniques such as FibroScan and ARFI are all valuable in assessment of hepatic fibrosis, while FibroScan and ARFI have better diagnostic value. ARFI is convenient to application for its integration with the ordinary ultrasound system. The sensitivity and specificity for diagnosis of hepatic fibrosis could be improved by combining serological model with FibroScan or ARFI. Combination of APRI and ARFI show the highest accuracy in diagnosis of hepatic fibrosis. Combination of serological models and transient elastic liver imaging is recommended for assessment and follow-up of HBV-related fibrosis.
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Objective: To investigate the correlation between FIB-4 and the clinicopathological characteristics and prognosis of patients with hepatocellular carcinoma (HCC) after curative resection. Methods: From January 2009 to December 2012, the clinicopathological and follow-up data of 245 patients with HCC after curative resection were retrospectively studied. Their survival was calculated using the Kaplan-Meier method. The Cox proportional hazard regression model was used for the multivariate analysis. Results: According to FIB-4 index, patients were divided into two subgroups: FIB-4Ⅰ(≤3.25) and FIB-4Ⅱ(>3.25). FIB-4 could predict liver cirrhosis severity (Ishak grade, Grade 1-5 vs. Grad 6, r=0.681, P<0.001). It was associated with liver function such as:aspartate transaminase (P<0.001)、total bilirubin (P=0.009)、albumin (P=0.001) and platelet count (P<0.001) other than tumor clinicopathologic features. Both univariate and multivariate analysis showed FIB-4 could predict the prognosis of HCC patients (Overall survival: P=0.037 and 0.011; Recurrencefree survival: P=0.027 and P=0.043, respectively). Conclusion: The preoperative FIB-4 index could be used as a prognostic marker for the prognosis of HCC after curative hepatectomy.
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Objective To explore the value of FIB-4 and APRI index on evaluating the severity of liver fibrosis among patients with chronic hepatitis B(CHB).Methods A total of 218 CHB were enrolled in the study.Based on the staging of liver fibrosis,the patients were divided into 2 groups as S0-S2 group(n=120) and S3-S4 group(n=98).Differences in clinical data,laboratory indexes,FIB-4 and APRI index were compared between two groups.The correlation between FIB-4 index,APRI index and liver fibrosis were analyzed by Spearman correlation test.Receiver operator curve(ROC) test was used to determine the evaluating value of FIB-4 index and APRI index for the severity of liver fibrosis.Results To evaluate the staging≥S2 of liver fibrosis,the value of FIB-4 index was better than APRI index(Z=1.998,P=0.046).And to evaluate the staging≥S3 and S4 of liver fibrosis,the value of FIB-4 index for evaluating the staging≥S3(Z=1.177,P=0.239) or S4(Z=0.267,P=0.789) was the same as APRI index.Conclusion FIB-4 index and APRI index are both effective on evaluating the severity of liver fibrosis among patients with CHB,but the value of FIB-4 index is better than APRI index for evaluating early liver fibrosis.
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Background:The diagnostic accuracy of APRI and FIB-4 for liver fibrosis in patients with chronic hepatitis B is nothigh,especially for significant liver fibrosis (F≥2). Noninvasive diagnosis for liver fibrosis has become a research hotspot;and the diagnostic value of APRI combined with FIB-4 is not clear. Aims:To investigate the diagnostic value ofAPRI combined with FIB-4 for significant liver fibrosis in patients with chronic hepatitis B. Methods:A total of 171patients with chronic hepatitis B from January 2011 to October 2016 at General Hospital of Xinjiang Military Region wereenrolled. Liver biochemical indices,routine blood test and liver biopsy pathology were performed. APRI and FIB-4 werecalculated,ROC curve was drawn,and cutoff value of APRI and FIB-4 for diagnosing significant liver fibrosis wasdetermined,and mode of APRI combined with FIB-4 for diagnosing significant liver fibrosis was established. Results:Withthe increase in degree of liver fibrosis,APRI and FIB-4 were gradually increased (P < 0. 05). Area under ROC curve(AUC)for APRI and FIB-4 were 0. 812 and 0. 770,respectively. The sensitivity of FIB-4 for diagnosing significant liverfibrosis was higher than that of APRI. Sensitivity,specificity,negative predictive value,positive predictive value,andaccuracy of APRI combined with FIB-4 for diagnosing significant liver fibrosis were superior to APRI or FIB-4 used alone;and the specificity,accuracy of mode 2 were superior to mode 1. Conclusions:APRI combined with FIB-4 can increasethe accuracy for diagnosing significant liver fibrosis.
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Objective To analyze the effects of 25-hydroxyvitamin D[25(OH)D]on the result of the HCV RNA and the FIB-4 in the patients with hepatitis C.Methods 255 serum samples were random collected from the patients with hepatitis C and 218 serum samples were random collected from the healthy people.The 25(OH)D,HCV RNA,aspartate aminotransferase (AST),alanine aminotransferase (ALT)and blood platelet (PLT)were detected.Then,compared the results of the 25 (OH)D in the patients with hepatitis C and the healthy group.Analyzed the relevance between the concentration of 25(OH) D and HCV RNA.According to the quartile concentration of the 25(OH)D,the patients with hepatitis C were categorized to four groups.The relationship of FIB-4 between HCVRNA and 25(OH)D was analyzed.Results The average concentration of the 25(OH)D in the patients with hepatitis C and healthy people were 48.16±1.41 nmol/L vs 60.42±1.34 nmol/L, with a significant difference (t=4.682,P<0.01).There were 38 patients (14.90%)had severe deficiency of 25(OH)D (<25 nmol/L)in 255 patients with hepatitis C.And there were 8 patients (3.67%)had severe deficiency of 25(OH)D (<25 nmol/L)in 218 healthy people,with a significant difference (t=5.216,P<0.01).Then found no relevance between the log-arithmic of the HCV RNA and the concentration of the 25(OH)D (r2=0.018 8,P=0.412)and there was significant differ-ence between the proportion of FIB-4 in the highest quartile concentration of the 25(OH)D and the lowest quartile concen-tration of the 25(OH)D (χ2=8.190,P=0.042).Conclusion The patients with hepatitis C were easier to have a severe de-ficiency of 25(OH)D than the healthy people.The hepatitis C patients should been suggested to supply the vitamin D.FIB-4 has a significant difference with 25(OH)D and no great effects on the result of the HCV RNA.
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BACKGROUND: Liver biopsy is the gold standard for assessing liver fibrosis; however, it has a relatively high risk of resulting in complications. Although a non-invasive method (i.e., transient elastography—fibroscan) was introduced, it is expensive and is dependent on the patient's status. Thus, the FIB-4 score, a non-invasive formula, has been used to predict the degree of liver fibrosis. The aim of this study was to evaluate the usefulness of the FIB-4 score in predicting stages of liver fibrosis. METHODS: We analysed the age, diagnosis, and liver stiffness of 282 patients by measuring the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) as well as their platelet count. Liver elasticity was evaluated by two classification criteria (Foucher et al. and Mueller et al.). The FIB-4 score was calculated using the formula: age×AST/(platelet count×ALT½). The cut-off value of the FIB-4 score was determined according to the area under the relative operating characteristic curve (AUC) based on liver elasticity. RESULTS: The FIB-4 cut-off values, as determined using two different criteria, have the highest AUC, thereby indicating a robust ability to distinguish between healthy liver tissue and the presence of any liver fibrosis. The FIB-4 score with a cut-off value of 2.07, as determined by Mueller et al., had the highest AUC (0.837) and odds ratio (2.741) with a sensitivity of 78.3% and a specificity of 76.5%. CONCLUSIONS: An FIB-4 score of 2.07 is a cut-off value that is useful in detecting fibrotic progression in chronic liver disease in our laboratory. Each laboratory should determine an appropriate FIB-4 cut-off value that is relative to the particular characteristics of their patient population.
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Humanos , Alanina Transaminasa , Área Bajo la Curva , Aspartato Aminotransferasas , Biopsia , Clasificación , Diagnóstico , Elasticidad , Cirrosis Hepática , Hepatopatías , Hígado , Tamizaje Masivo , Métodos , Oportunidad Relativa , Recuento de Plaquetas , Sensibilidad y EspecificidadRESUMEN
Objective To assess the prognostic value of APRI score and FIB-4 index for patients with chronic liver failure.Methods Clinical data of 426 patients with chronic liver failure admitted in the First Affiliated Hospital of Xinjiang Medical University from March 2005 to September 2014 were retrospectively analyzed.The MELD score,APRI score and FIB-4 index were calculated.Patients were divided into survival group and fatal group according to survival situation within 3 month after admission.Logistic regression was used to analyze the differences in all the indexes between the survival group and fatal group.Receiver operating characteristic (ROC) curve was used to assess the value of the above indexes in predicting the 3-month survival.Results Among 426 patients 244 died within three months after admission.Univariate analysis and multivariate Logistic regression showed that MELD score and FIB-4 index were statistically significant between the survival and fatal groups (Z =-4.783 and-4.104,x2 =26.31 and 11.34,both P ＜ 0.01).The area under the ROC curve of MELD score,APRI score and FIB-4 index was 0.635,0.511 and 0.616 for predicting 3-month survival,respectively.Compared with the APRI score,MELD score and FIB4 index were statistically different (x2 =13.669 and 6.341,P ＜ 0.05 or P ＜ 0.01).When MELD score ＞ 28,FIB-4 index ＞ 11.27,the patient has a high fatality rate and poor prognosis within three months.Conclusion FIB-4 index can be used to evaluate the short-term prognosis of patients with chronic liver failure,and the higher score of FIB-4 index predicts the worse prognosis.
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Objective To evaluate the clinical application of liver shear wave velocity (SWV) in comparison with common serum score systems [AST to platelet ratio index (APRI),Forns,S index and FIB-4] in assessment of liver fibrosis in patients with chronic hepatitis.Methods A total of 237 chronic hepatitis patients with liver fibrosis confirmed by liver biopsy,who were admitted in Ningbo Second Hospital during October 2010 and April 2013,were enrolled in the study.Liver shear wave velocity were measured by acoustic radiation force impulse (ARFI),and the score of APRI,Forns,S index and FIB-4 were calculated based on the measurement of serum markers.Liver fibrosis stages were classified as S0-S4 according to the Scheuer scoring system,and stages ≥ S2 were identified as significant liver fibrosis.The diagnosis value of SWV,4 common score systems and their combination for significant liver fibrosis was evaluated by receiver operating characteristic curve (ROC).Results A significant linear correlation was found between SWV and the stage of fibrosis (r =0.46,P ＜ 0.01).The areas under the ROCs of SWV and 4 common score systems (APRI,Forns,S index and FIB-4) for the diagnosis of significant liver fibrosis were 0.758 (0.696-0.821),0.727 (0.662-0.793),0.777 (0.717-0.836),0.747 (0.684-0.810) and 0.737 (0.673-0.802),respectively.The area under the ROC of the combined prediction nodel established with Logistic regression was 0.810.Conclusion Liver shear wave velocity measured by ARFI is of clinical value in noninvasive assessment of liver fibrosis,and the prediction accuracy can be improved when it is combined with other noninvasive indices.
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BACKGROUND/AIMS: The red-blood-cell distribution width (RDW) is a newly recognized risk marker in patients with cardiovascular disease, but its role in nonalcoholic fatty liver disease (NAFLD) has not been well defined. The aim of the present study was to determine the association between RDW values and the level of fibrosis in NAFLD according to BARD and FIB-4 scores. METHODS: This study included 24,547 subjects who had been diagnosed with NAFLD based on abdominal ultrasonography and questionnaires about alcohol consumption. The degree of liver fibrosis was determined according to BARD and FIB-4 scores. The association between RDW values and the degree of fibrosis in NAFLD was analyzed retrospectively. RESULTS: After adjusting for age, hemoglobin level, mean corpuscular volume, history of hypertension, history of diabetes, and high-sensitivity C-reactive protein, the RDW values were 12.61+/-0.41% (mean+/-SD), 12.70+/-0.70%, 12.77+/-0.62%, 12.87+/-0.82%, and 13.25+/-0.90% for those with BARD scores of 0, 1, 2, 3, and 4, respectively, and 12.71+/-0.72%, 12.79+/-0.66%, and 13.23+/-1.52% for those with FIB-4 scores of or =2.67, respectively (P or =1.3) increased with the RDW [BARD score: 51.1% in quartile 1 (Q1) vs. 63.6% in Q4; FIB-4 score: 6.9% in Q1 vs. 10.5% in Q4; P<0.001]. After adjustments, the odds ratio of having advanced fibrosis for those in Q4 compared to Q1 were 1.76 (95%CI=1.55-2.00, P<0.001) relative to BARD score and 1.69 (95%CI=1.52-1.98, P<0.001) relative to FIB-4 score. CONCLUSIONS: Elevated RDW is independently associated with advanced fibrosis in NAFLD.
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Consumo de Bebidas Alcohólicas , Proteína C-Reactiva/análisis , Diabetes Mellitus/patología , Índices de Eritrocitos , Hígado Graso/complicaciones , Hipertensión/patología , Cirrosis Hepática/diagnóstico , Oportunidad Relativa , Prevalencia , Encuestas y Cuestionarios , Índice de Severidad de la EnfermedadRESUMEN
Objective To assess the value of S index and FIB-4 for diagnosis of liver fibrosis in patients with chronic hepatitis B (CHB) by comparing with traditional indexes APRI and Forns.Methods A total of 361 patients with confirmed CHB from the First Hospital of Nanjing Medical University and Huashan Hospital Affiliated to Fudan University during January 2006 and December 2011 were enrolled in the study.The clinical,laboratory and pathological data of patients were collected.Four noninvasive score systems APRI,Forns,S index and FIB-4 were computed.With liver biopsy as the gold standard,the area under the ROC curve (AUROC) was used to assess the value of above 4 score systems in diagnosis of liver fibrosis,and Z test was performed to evaluate the effectiveness of above systems.Results The areas under ROC curve (AUCs) of APRI,Forns,S index and FIB-4 for significant fibrosis (≥S2) were (0.737 ±0.027),(0.716 ± 0.028),(0.745 ± 0.026) and (0.781 ± 0.025),respectively.When the cut off value of FIB-4 was set at 1.62,the sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) for diagnosis of significant fibrosis were 59.3％,85.8％,89.4％ and 51.2％,respectively,which were better than Forn index (Z =3.28,P =0.001).While for S4 (cirrhosis) the AUCs of APRI,Foms,S index and FIB-4 were (0.687 ± 0.035),(0.792 ± 0.028),(0.863 ± 0.024) and (0.832 ± 0.025),respectively.When the cut off value of S index was set at 1.06,the sensitivity,specificity,PPV and NPV for diagnosis of cirrhosis were 77.9％,85.5％,59.4％ and 93.5％,respectively,which were better than APRI and Forns (Z =6.74 and 3.21,P ＜ 0.01).Conclusions APRI,Forns,S index and FIB-4 are simple and accurate methods for assessing liver fibrosis.FIB-4 and S index are better than APRI and Forns in diagnosis of significant fibrosis and cirrhosis,which may replace liver biopsy in certain extend.