Department of Health Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy.
2nd Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.
Medicina (Kaunas). 2024 Nov 12;60(11):1854. doi: 10.3390/medicina60111854.
Liver cirrhosis is a chronic, progressive condition characterized by fibrosis and architectural distortion of the liver, leading to impaired liver function and severe complications. Accurately predicting these complications is crucial to the improvement of patient outcomes. Therefore, this study aimed to evaluate the accuracy of various non-invasive biomarkers and clinical scores in assessing the risk of complications among cirrhotic patients. We conducted an observational retrospective study involving 236 cirrhotic patients from two tertiary care hospitals in Italy and Romania, in a timespan ranging from January 2021 to March 2024. Data on clinical characteristics, liver function tests, hematological indices, various non-invasive biomarkers, and clinical scores were collected and analyzed. Receiver operating characteristic analysis was performed to assess the accuracy of these biomarkers and clinical scores in predicting complications, including the presence of varices and hepato-renal syndrome. The Child-Pugh score showed the highest accuracy for cirrhosis-related complications, with an area under curve (AUC) = 0.667. The red cell distribution width coefficient of variation followed closely with an AUC = 0.646. While the Child-Pugh score had a high specificity (85.42%), its sensitivity was low (37.97%). In patients with varices, non-invasive scores such as platelet distribution width (PDW) and the RDW-to-platelet ratio (RPR) showed modest predictive ability, with an AUC = 0.594. For hepato-renal syndrome, the Model for End-Stage Liver Disease (MELD) score showed the highest diagnostic accuracy with an AUC = 0.758. The most reliable biomarkers for detecting complications, varices, and hepato-renal syndrome, are, respectively, the Child-Pugh Score, PDW along with RPR, and the MELD score. However, while these scores remain valuable, the moderate diagnostic accuracy of other indices suggests the need for a more integrated approach to risk stratification. Future research should focus on validating these tools across different populations and incorporating emerging biomarkers to enhance predictive accuracy and inform more effective clinical decision-making.
肝硬化是一种慢性、进行性疾病，其特征为肝脏纤维化和结构扭曲，导致肝功能受损和严重并发症。准确预测这些并发症对于改善患者预后至关重要。因此，本研究旨在评估各种非侵入性生物标志物和临床评分在评估肝硬化患者并发症风险中的准确性。
我们进行了一项观察性回顾性研究，纳入了来自意大利和罗马尼亚的两家三级护理医院的 236 例肝硬化患者，研究时间为 2021 年 1 月至 2024 年 3 月。收集并分析了患者的临床特征、肝功能试验、血液学指标、各种非侵入性生物标志物和临床评分的数据。进行了受试者工作特征分析，以评估这些生物标志物和临床评分在预测并发症（包括静脉曲张和肝肾综合征的存在）中的准确性。
Child-Pugh 评分在预测与肝硬化相关的并发症方面表现出最高的准确性，曲线下面积（AUC）为 0.667。红细胞分布宽度变异系数紧随其后，AUC 为 0.646。虽然 Child-Pugh 评分具有较高的特异性（85.42%），但其敏感性较低（37.97%）。在静脉曲张患者中，血小板分布宽度（PDW）和红细胞分布宽度与血小板比值（RPR）等非侵入性评分显示出中等的预测能力，AUC 为 0.594。对于肝肾综合征，终末期肝病模型（MELD）评分显示出最高的诊断准确性，AUC 为 0.758。
用于检测并发症、静脉曲张和肝肾综合征的最可靠生物标志物分别是 Child-Pugh 评分、PDW 与 RPR 和 MELD 评分。然而，虽然这些评分仍然具有价值，但其他指数的中等诊断准确性表明需要更综合的风险分层方法。未来的研究应集中在验证这些工具在不同人群中的有效性，并结合新兴的生物标志物，以提高预测准确性并为更有效的临床决策提供信息。
