Background and aims:Hepatitis B virus(HBV)infection is a major public health issue worldwide as it may cause serious liver diseases such as cirrhosis and hepatocellular carcinoma(HCC).Ruling out cirrhosis is important...Background and aims:Hepatitis B virus(HBV)infection is a major public health issue worldwide as it may cause serious liver diseases such as cirrhosis and hepatocellular carcinoma(HCC).Ruling out cirrhosis is important when treating chronic hepatitis B(CHB).The aim of this study was to compare the performance of the aspartate aminotransferase-to-platelet ratio index(APRI),fibrosis score based on four factors(FIB-4),and red cell volume distribution width-to-platelet ratio(RPR)in diagnosing liver fibrosis stages and to identify new cut-off values to rule out cirrhosis.Methods:Between 2005 and 2020,2182 eligible individuals who underwent liver biopsy were randomly assigned to derivation and validation cohorts in a 6:4 ratio.A grid search was applied to identify optimal cut-off values with a sensitivity of>90% and a negative predictive value(NPV)of at least 95%.Results:Overall,1309 individuals(175 patients with cirrhosis)were included in the derivation dataset,and 873(117 patients with cirrhosis)were included in the validation cohort.The area under the receiver operating characteristic curve of RPR for diagnosing cirrhosis was 0.821,which was comparable to that of APRI(0.818,P=0.7905)and FIB-4(0.803,P=0.2395).When applying an RPR of 0.06,cirrhosis was correctly identified with a sensitivity of 93.1% and an NPV of 97.1%,while it misclassified 12 of 175(6.9%)patients in the derivation cohort.In the validation cohort,RPR had a sensitivity and NPV of 97.4% and 99.0%,respectively,and only misclassified 3 of 117(2.6%)patients.Subgroup analysis indicated that the new RPR cut-off value performed more consistently than that of APRI and FIB-4 in all subgroups.Conclusion:A recently established cut-off value for RPR(≤0.06)was validated and was more effective than APRI and FIB-4 in excluding patients with cirrhosis due to a higher sensitivity and NPV and a lower misclassification rate.This simple and dependable test could have significant clinical implications in identifying patients who require monitoring for portal hypertensio展开更多
目的探讨AST和PLT比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)联合血氨对肝硬化并肝性脑病(hepatic encephalopathy,HE)肝硬化患者诊断的价值。方法对48例无HE和48例伴有HE肝硬化患者分别进行AST、PLT和血氨检...目的探讨AST和PLT比率指数(aspartate aminotransferase-to-platelet ratio index,APRI)联合血氨对肝硬化并肝性脑病(hepatic encephalopathy,HE)肝硬化患者诊断的价值。方法对48例无HE和48例伴有HE肝硬化患者分别进行AST、PLT和血氨检测,并分析APRI、血氨值与HE之间的关系。结果伴有HE患者的Child分级和MELD评分均高于无HE者,差异有统计学意义(P<0.05)。APRI值在HE组的值为4.38±2.68,高于无HE组的2.19±1.75,差异有统计学意义(t=-4.721,P<0.001)。APRI值在不同HE分级中的分布:1级3.70±0.55、2级5.30±0.43、3~4级5.75±1.27,1级<2级<3~4级,差异有统计学意义(H=6.704,P=0.035)。血氨值在不同HE分级中的分布:1级(108.0±6.1)μg/dl、2级(130.4±23.4)μg/dl、3~4级(170.5±12.5)μg/dl,1级<2级<3~4级,差异有统计学意义(H=10.95,P=0.004)。APRI与血氨联合诊断HE时,ROC曲线下面积为0.898,敏感度为91.8%,特异度为96.9%。结论 APRI和血氨联合检测诊断HE效能较高,具有较好的临床应用价值。展开更多
基金supported by grants from the Natural Science Foundation of Guangdong Province for Distinguished Young Scholar(2022B1515020024)the National Natural Science Foundation of China(82070574)the Natural Science Foundation Team Project of Guangdong Province(2018B030312009).
文摘Background and aims:Hepatitis B virus(HBV)infection is a major public health issue worldwide as it may cause serious liver diseases such as cirrhosis and hepatocellular carcinoma(HCC).Ruling out cirrhosis is important when treating chronic hepatitis B(CHB).The aim of this study was to compare the performance of the aspartate aminotransferase-to-platelet ratio index(APRI),fibrosis score based on four factors(FIB-4),and red cell volume distribution width-to-platelet ratio(RPR)in diagnosing liver fibrosis stages and to identify new cut-off values to rule out cirrhosis.Methods:Between 2005 and 2020,2182 eligible individuals who underwent liver biopsy were randomly assigned to derivation and validation cohorts in a 6:4 ratio.A grid search was applied to identify optimal cut-off values with a sensitivity of>90% and a negative predictive value(NPV)of at least 95%.Results:Overall,1309 individuals(175 patients with cirrhosis)were included in the derivation dataset,and 873(117 patients with cirrhosis)were included in the validation cohort.The area under the receiver operating characteristic curve of RPR for diagnosing cirrhosis was 0.821,which was comparable to that of APRI(0.818,P=0.7905)and FIB-4(0.803,P=0.2395).When applying an RPR of 0.06,cirrhosis was correctly identified with a sensitivity of 93.1% and an NPV of 97.1%,while it misclassified 12 of 175(6.9%)patients in the derivation cohort.In the validation cohort,RPR had a sensitivity and NPV of 97.4% and 99.0%,respectively,and only misclassified 3 of 117(2.6%)patients.Subgroup analysis indicated that the new RPR cut-off value performed more consistently than that of APRI and FIB-4 in all subgroups.Conclusion:A recently established cut-off value for RPR(≤0.06)was validated and was more effective than APRI and FIB-4 in excluding patients with cirrhosis due to a higher sensitivity and NPV and a lower misclassification rate.This simple and dependable test could have significant clinical implications in identifying patients who require monitoring for portal hypertensio
