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

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.

Keywords

• |esophageal and gastric varices|age-male-albi-platelets|aspartate aminotransferase-to-platelet ratio index|fibrosis index based on the 4 factors|liver stiffness measurement