Farid K, Omran M M, Farag R E, Arafa M M, Emran T M
a Faculty of Medicine, Tropical Medicine Department , Mansoura University , Mansoura , Egypt.
b Faculty of Science, Chemistry Department , Helwan University , Cairo , Egypt.
Br J Biomed Sci. 2017 Jul;74(3):138-143. doi: 10.1080/09674845.2017.1297217. Epub 2017 May 15.
Variceal bleeding is one of the most common life-threatening complications of liver cirrhosis. This study aimed to develop and evaluate a predictive score, named Platelet count, Alpha fetoprotein (AFP) and Prothrombin-INR (PAP) for the prediction of large oesophageal varices and to compare PAP score with eight common liver fibrosis scores (AAR, APRI, GUCI, BRC score, Fibro-Alfa, FIB4, Lok and Fibro-Q) in patients with hepatitis C virus (HCV) induced liver cirrhosis.
A total of 277 patients with HCV-induced liver cirrhosis were evaluated by upper gastrointestinal endoscopy for presence of varices. Liver biochemical profile, complete blood count, prothrombin time and AFP were estimated. Stepwise linear discriminant analysis and area under receiver-operating characteristic curves (AUCs) were used to create a predictive score (PAP score) comprising platelet count, AFP and prothrombin-INR.
PAP score predicts large oesophageal varices in patients with HCV-induced liver cirrhosis with AUC of 0.85. The optimum cut-off for predicting large oesophageal varices using ROC curve analysis was 0.27. At this point the PAP score had 77% sensitivity, 86% specificity, 94% negative predictive value and 84% efficiency. The diagnostic performances (AUC) of eight common liver fibrosis scores were 0.58 for the AAR score, 0.63 for APRI, 0.66 for GUCI, 0.68 for BRC, 0.72 for Fibro-Alfa, 0.70 for FIB4, 0.72 for Lok and 0.77 for Fibro-Q.
PAP scores a non-invasive, inexpensive and simple score that could predict the presence of large oesophageal varices reducing the need of endoscopy. The PAP score has a superior AUC score than other scores, suggesting improved clinical value.
静脉曲张破裂出血是肝硬化最常见的危及生命的并发症之一。本研究旨在开发并评估一种名为血小板计数、甲胎蛋白（AFP）和凝血酶原 - INR（PAP）的预测评分系统，用于预测大食管静脉曲张，并将PAP评分与丙型肝炎病毒（HCV）所致肝硬化患者的八项常见肝纤维化评分（AAR、APRI、GUCI、BRC评分、Fibro - Alfa、FIB4、Lok和Fibro - Q）进行比较。
对总共277例HCV所致肝硬化患者进行上消化道内镜检查以评估静脉曲张的存在情况。检测肝生化指标、全血细胞计数、凝血酶原时间和AFP。采用逐步线性判别分析和受试者操作特征曲线下面积（AUC）来创建一个包含血小板计数、AFP和凝血酶原 - INR的预测评分（PAP评分）。
PAP评分预测HCV所致肝硬化患者大食管静脉曲张的AUC为0.85。使用ROC曲线分析预测大食管静脉曲张的最佳截断值为0.27。此时，PAP评分的灵敏度为77%，特异度为86%，阴性预测值为94%，效率为84%。八项常见肝纤维化评分的诊断性能（AUC）分别为：AAR评分为0.58，APRI为0.63，GUCI为0.66，BRC为0.68，Fibro - Alfa为0.72，FIB4为0.70，Lok为0.72，Fibro - Q为0.77。
PAP评分是一种无创、廉价且简单的评分系统，可预测大食管静脉曲张的存在，减少内镜检查的需求。PAP评分的AUC得分优于其他评分，表明其临床价值更高。
