Non-invasive fibrosis indexes in assessment of esophageal varices in patients with hepatitis B virus-related cirrhosis / 中华传染病杂志

ABSTRACT

Objective To investigate the predictive value of red cell volume distribution width RDW),RDW to platelet ratio (RPR),aspartate aminotransferase (AST) to platelet ratio index APRI),fibrosis index based on the 4 factor (FIB-4) and aspartate-alanine aminotransferase ratio (AAR) in assessing esophageal varices (EV) in patients with hepatitis B virus (HBV)-related cirrhosis.Methods Between December 2013 and July 2015,a total of 190 patients with HBV-related cirrhosis and no previous history of endoscopic therapy for EV hospitalized at the Department of Hepatology,Tianjin Third Central Hospital were enrolled.Upper gastrointestinal endoscopy were conducted in all patients to diagnose EV.According to the morphology and degree of EV as well as bleeding risk,patients were categorized into mild,moderate and severe stages.RDW,platelet counts,alanine aminotransferase,aspartate aminotransferase were tested,and RPR,APRI,FIB-4,AAR were calculated.Spearman correlation was used to evaluate the association between EV and these indexes.Receive operating characteristic (ROC) curves were generated and the areas under the curves (AUC) were calculated to assess the performance of these indexes in predicting esophageal varices bleeding (EVB).Results RDW ([16.78±2.27]％),RPR (0.41±0.18),FIB4 (8.99±5.91),APRI (2.09[1.35,2.90]) in patients with EVB were all significantly higher than those ([14.37±1.86]％,t=-7.449;0.19±0.09 [t=-8.132];5.72±3.92 [t=-3.658];1.29 [0.70,2.39;z=-2.996]) without EVB (all P＜0.05).However,AAR had no statistical significance between two groups (t =1.216,P=0.226).Both of EV and EVB had positive correlation with RDW,RPR,FIB-4 and APRI (all P＜0.05) and no correlation withAAR(P＞0.05).RDW (F=9.604),RPR (F=47.530),FIB-4 (F=18.071) and APRI (H=12.320) showed statistically significant differences among patients with different stages of EV (all P＜0.05),whereas AAR showed no difference (F=1.177,P=0.320).The AUC of RPR (0.896) for EVB was highest,followed by RDW (0.824,P＜0.05).AUC of FIB-4 and APRI was 0.690 and 0.642,respectively,with no statistical difference (P＞0.05).The optimal cut-off levels of RDW,RPR,FIB-4 and APRI were 14.450 (sensitivity88.24％,specificity64.03％),0.209 (sensitivity96.10％,specificity69.10％),6.912 (sensitivity66.67％,specificity73.38％) and 1.338 (sensitivity76.47％,specificity51.08％),respectively.Conclusions RPR and RDW are closely correlated with EV in HBV-related cirrhotic patients,which are of clinical importance in predicting EVB.Both of them can be used as clinical screening methods and RPR may be superior to RDW.Although FIB-4 and APRI are correlated with EV,their predictive value of EBV are low.