Pavan Sai Kumar Rao D, Patro Shubhransu, Sharma Vibha, Choudhary Arushi, Desale Shubham, Nath Preetam
Department of Medical Gastroenterology, Gleneagles BGS Global Hospitals, Bengaluru, IND.
General Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.
Cureus. 2025 Apr 10;17(4):e82014. doi: 10.7759/cureus.82014. eCollection 2025 Apr.
Background Early diagnosis of liver cirrhosis in patients with chronic liver disease (CLD) can help delay/prevent complications and thereby improve survival. The currently available diagnostic modalities for the non-invasive assessment of hepatic fibrosis, especially FibroScan, are costly and not widely available, whereas various non-invasive scores for the assessment of fibrosis are cumbersome. Hence, we aimed to develop an easy and simple score for predicting cirrhosis in patients from Eastern India suffering from CLD with a better diagnostic accuracy. Methodology This cross-sectional, observational study was conducted between September 2019 and September 2021 in East India. Our study participants were patients who had CLD of etiologies such as alcohol-related liver disease, non-alcoholic fatty liver disease, chronic viral hepatitis B, chronic viral hepatitis C, primary biliary cholangitis, and autoimmune hepatitis, who had undergone FibroScan of the liver. All demographic details were noted, and the patients were subjected to physical examination, followed by hematological as well as biochemical investigations, including liver function tests. Non-invasive scores (such as aspartate aminotransferase (AST) to platelet ratio index (APRI) and Fibrosis-4 score (FIB-4) and red cell distribution width (RDW) to platelet ratio (RPR)) were computed, and their diagnostic accuracy for prediction of advanced fibrosis and cirrhosis were evaluated by receiver operating characteristic curve (ROC curve) analysis with comparison of area under the ROC curves. Pearson correlation and logistic regression analysis were also performed to study the association of these scores with advanced fibrosis and cirrhosis. Results The area under the ROC (AUROC) curve of the APRI score, FIB-4 score, RPR, and RPR × AST for prediction of advanced liver fibrosis was 0.817, 0.799, 0.706, and 0.811, respectively. Similarly, the AUROC of the above scores for the prediction of cirrhosis was 0.889, 0.858, 0.797, and 0.898. However, the product of RPR and AST was superior than APRI and FIB-4 for predicting cirrhosis. An RPR × AST value above the cut-off of 4.818 can help predict liver cirrhosis with 85.7% sensitivity and 85.5% specificity. Pearson correlation and logistic regression analysis also proved the association of these scores with liver fibrosis. Conclusions RPR is a simple, inexpensive, and easily available marker for predicting liver cirrhosis. Nevertheless, the variable RPR × AST can predict liver cirrhosis in patients with CLD with even greater diagnostic accuracy.
背景 慢性肝病（CLD）患者肝硬化的早期诊断有助于延缓/预防并发症，从而提高生存率。目前用于肝纤维化无创评估的诊断方法，尤其是FibroScan，成本高昂且未广泛普及，而用于评估纤维化的各种无创评分又很繁琐。因此，我们旨在开发一种简单易行的评分方法，以更高的诊断准确性预测印度东部CLD患者的肝硬化情况。
方法 这项横断面观察性研究于2019年9月至2021年9月在印度东部进行。我们的研究参与者是患有酒精性肝病、非酒精性脂肪性肝病、慢性乙型病毒性肝炎、慢性丙型病毒性肝炎、原发性胆汁性胆管炎和自身免疫性肝炎等病因的CLD患者，他们均接受了肝脏FibroScan检查。记录所有人口统计学细节，对患者进行体格检查，随后进行血液学和生化检查，包括肝功能测试。计算无创评分（如天冬氨酸氨基转移酶（AST）与血小板比值指数（APRI）、纤维化-4评分（FIB-4）以及红细胞分布宽度（RDW）与血小板比值（RPR）），并通过受试者操作特征曲线（ROC曲线）分析评估其预测晚期纤维化和肝硬化的诊断准确性，比较ROC曲线下面积。还进行了Pearson相关性分析和逻辑回归分析，以研究这些评分与晚期纤维化和肝硬化的关联。
结果 APRI评分、FIB-4评分、RPR以及RPR×AST预测晚期肝纤维化的ROC曲线下面积（AUROC）分别为0.817、0.799、0.706和0.811。同样，上述评分预测肝硬化的AUROC分别为0.889、0.858、0.797和0.898。然而，RPR与AST的乘积在预测肝硬化方面优于APRI和FIB-4。RPR×AST值高于临界值4.818有助于预测肝硬化，灵敏度为85.7%，特异度为85.5%。Pearson相关性分析和逻辑回归分析也证实了这些评分与肝纤维化的关联。
结论 RPR是一种简单、廉价且易于获得的预测肝硬化的标志物。尽管如此，变量RPR×AST在预测CLD患者肝硬化方面具有更高的诊断准确性。
