Liver fibrosis indices predict portal hypertension in cirrhotic patients
In a study cohort of 238 liver cirrhosis patients (mean age 52.55±10.44 years), 78.99 percent (n=188) had clinically significant PH (CSPH) while 68.49 percent (n=163) had severe PH (SPH).
Multivariate analysis showed that aminotransferase (AST; odds ratio [OR], 1.033; 95 percent CI, 1.031 to 1.034; p=0.005), platelet (PLT) count (OR, 0.993; 0.990 to 0.995; p=0.002) and albumin (OR, 0.943; 0.940 to 0.947; p=0.026) were independently and significantly associated with hepatic venous pressure gradient (HVPG) grade.
The resulting HVPG prediction model yielded areas under the curve (AUCs) of 0.780 (0.722 to 0.831) and 0.769 (0.711 to 0.821) for the prediction of CSPH and SPH, respectively. The corresponding sensitivities were 68.62 and 69.33 percent, while the specificities were 80.0 and 74.67 percent, respectively.
Of the live fibrosis indices used, King’s score (AUC, 0.755), AST-to-PLT ratio index (APRI; AUC, 0.742) and Lok index (AUC, 0.740) had the best diagnostic performance for CSPH. APRI showed the highest accuracy (76.89 percent), while King’s score was significantly better than FIB-4 (p=0.0002) and Forns index (p=0.0002).
For SPH, receiver operating curve analysis showed that King’s score (AUC, 0.742), APRI (AUC, 0.722) and Lok index (AUC, 0.717) again had the best diagnostic performance. Lok index had the highest accuracy (68.91 percent).
Lok index and King’s score were then combined. The resulting diagnostic performance outcome for CSPH was a 52.7 percent sensitivity and 90.4 percent specificity. For SPH, the sensitivity of the model was 34.55 percent while its specificity was 94.7 percent.