Kirnake Vijendra, Arora Anil, Sharma Praveen, Goyal Mohan, Chawlani Romesh, Toshniwal Jay, Kumar Ashish
Institute of Liver, Gastroenterology, and Panceatico-Biliary Sciences, Ganga Ram Institute for Postgraduate Medical Education and Research, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India.
Department of Medicine and Gastroenterology, Acharya Vinoba Bhave Rural Hospital and Jawaharlal Nehru Medical College, Sawangi (M), Wardha, 442 001, India.
Indian J Gastroenterol. 2018 Jul;37(4):335-341. doi: 10.1007/s12664-018-0879-0. Epub 2018 Sep 3.
Hepatic venous pressure gradient (HVPG) is the best recommended tool to measure portal pressure, but is invasive. HVPG helps in prognosticating cirrhosis and predict its complications. Aminotransferase to platelet ratio index (APRI) is a simple non-invasive marker of hepatic fibrosis. We aimed to correlate APRI with HVPG and to determine the usefulness of APRI in predicting complication of cirrhosis.
APRI and HVPG were measured in consecutive patients of cirrhosis aged 18 to 70 years. Spearman's rho was used to estimate their correlation; a cut-off value of APRI to predict severe portal hypertension (HVPG > 12 mmHg) was determined.
This study, conducted between August 2011 and December 2014, included 277 patients, median age 51 (range: 16-90) years, 84% males. Etiology of cirrhosis was alcohol in 135 (49%), cryptogenic/nonalcoholic steatohepatitis (NASH) in 104 (38%), viral in 34 (12%), and others in 4 (1%). Median Child-Turcott-Pugh (CTP) and model for end-stage liver disease (MELD) scores were 7 (5-11) and 11 (6-33), respectively. Median HVPG was 17.0 (1.5-33) mmHg and median APRI was 1.09 (0.21-12.22). There was positive correlation between APRI and HVPG (Spearman's rho 0.450, p < 0.001). The area under the receiver operating characteristic (ROC) curve of APRI for predicting severe portal hypertension was 0.763 (p < 0.01). Youden's index defined the cut-off of APRI for predicting HVPG > 12 mmHg was 0.876 with a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 71%, 78%, 94%, 38%, and 73%, respectively. APRI also correlated well with CTP, variceal size, bleeding status, ascites but not with MELD.
APRI score of 0.876 has an acceptable accuracy to predict severe portal hypertension (HVPG > 12 mmHg). High APRI also correlated with severity of cirrhosis and its complications. Thus, APRI may be used as a simple, bedside, non-invasive, and inexpensive tool for evaluating portal hypertension and complications of cirrhosis.
肝静脉压力梯度（HVPG）是推荐用于测量门静脉压力的最佳工具，但具有侵入性。HVPG有助于对肝硬化进行预后评估并预测其并发症。天冬氨酸氨基转移酶与血小板比值指数（APRI）是肝纤维化的一种简单非侵入性标志物。我们旨在将APRI与HVPG进行相关性分析，并确定APRI在预测肝硬化并发症方面的实用性。
对18至70岁的连续性肝硬化患者测量APRI和HVPG。采用Spearman等级相关系数来估计它们之间的相关性；确定预测严重门静脉高压（HVPG>12 mmHg）的APRI临界值。
本研究于2011年8月至2014年12月进行，纳入277例患者，中位年龄51岁（范围：16 - 90岁），男性占84%。肝硬化病因中，酒精性135例（49%），隐源性/非酒精性脂肪性肝炎（NASH）104例（38%），病毒性34例（12%），其他4例（1%）。Child-Turcott-Pugh（CTP）评分中位数为7分（5 - 11分），终末期肝病模型（MELD）评分中位数为11分（6 - 33分）。HVPG中位数为17.0 mmHg（1.5 - 33 mmHg），APRI中位数为1.09（0.21 - 12.22）。APRI与HVPG呈正相关（Spearman等级相关系数0.450，p<0.001）。APRI预测严重门静脉高压的受试者工作特征（ROC）曲线下面积为0.763（p<0.01）。约登指数确定预测HVPG>12 mmHg的APRI临界值为0.876，其敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别为71%、78%、94%、38%和73%。APRI与CTP、静脉曲张大小、出血状态、腹水也有良好的相关性，但与MELD无关。
APRI评分0.876在预测严重门静脉高压（HVPG>12 mmHg）方面具有可接受的准确性。高APRI也与肝硬化的严重程度及其并发症相关。因此，APRI可作为一种简单、床边、非侵入性且廉价的工具，用于评估门静脉高压和肝硬化并发症。
