Vipin Verma1, Shiv Kumar Sarin2, Praveen Sharma3, Ashish Kumar3. 1. Maulana Azad Medical College, New Delhi, India. 2. Institute of Liver and Biliary Sciences, New Delhi, India ; GB Pant Hospital, New Delhi, India. 3. Sir Ganga Ram Hospital, New Delhi, India.
Abstract
BACKGROUND: Hepatic venous pressure gradient (HVPG) is a prognostic marker in cirrhosis, but is invasive. There is a need to validate a noninvasive marker to measure portal hypertension. Aspartate aminotransferase/platelet ratio index (APRI) is proposed as a good noninvasive estimator of hepatic fibrosis. Whether APRI could be used as noninvasive tool to measure portal hypertension has not been studied. AIM: To correlate APRI with HVPG in patients with cirrhosis and to determine the diagnostic usefulness of the APRI in detection of high portal pressure. METHODS: APRI and HVPG were measured in consecutive patients of cirrhosis aged 18-75 years, with serum bilirubin <5 mg/dl, Child-Turcotte-Pugh (CTP) score ≤12, and without evidence of acute-on-chronic liver failure or flare. RESULTS: This study included 74 patients (median age 47 years, range 20-70 years; 57 males, (77%). The aetiology of cirrhosis was: viral 33 (45%), alcohol 10 (14%), and cryptogenic and others 31 (42%). The median HVPG was 16 mmHg (range 2-28 mmHg). The median APRI was 1.19 (range 0.17-7.92). There was significant correlation between HVPG and APRI (Spearman's rho 0.365; p = 0.001). The ROC curve to study the performance of APRI for predicting high portal pressure (HVPG >12 mmHg) had area under curve 0.716 (95% CI 0.574-0.858). An APRI of ≥1.09 had a sensitivity 66%, specificity 73%, positive predictive value 85%, negative predictive value 47%, and diagnostic accuracy 68% for predicting HVPG >12 mmHg. CONCLUSIONS: APRI correlates fairly with HVPG in patients of cirrhosis. An APRI score of ≥1.09 seems to have an acceptable accuracy for prediction of high portal pressure. APRI is a fair, bedside, cost-effective parameter for diagnosis of high portal pressure in patients with cirrhosis.
BACKGROUND: Hepatic venous pressure gradient (HVPG) is a prognostic marker in cirrhosis, but is invasive. There is a need to validate a noninvasive marker to measure portal hypertension. Aspartate aminotransferase/platelet ratio index (APRI) is proposed as a good noninvasive estimator of hepatic fibrosis. Whether APRI could be used as noninvasive tool to measure portal hypertension has not been studied. AIM: To correlate APRI with HVPG in patients with cirrhosis and to determine the diagnostic usefulness of the APRI in detection of high portal pressure. METHODS: APRI and HVPG were measured in consecutive patients of cirrhosis aged 18-75 years, with serum bilirubin <5 mg/dl, Child-Turcotte-Pugh (CTP) score ≤12, and without evidence of acute-on-chronic liver failure or flare. RESULTS: This study included 74 patients (median age 47 years, range 20-70 years; 57 males, (77%). The aetiology of cirrhosis was: viral 33 (45%), alcohol 10 (14%), and cryptogenic and others 31 (42%). The median HVPG was 16 mmHg (range 2-28 mmHg). The median APRI was 1.19 (range 0.17-7.92). There was significant correlation between HVPG and APRI (Spearman's rho 0.365; p = 0.001). The ROC curve to study the performance of APRI for predicting high portal pressure (HVPG >12 mmHg) had area under curve 0.716 (95% CI 0.574-0.858). An APRI of ≥1.09 had a sensitivity 66%, specificity 73%, positive predictive value 85%, negative predictive value 47%, and diagnostic accuracy 68% for predicting HVPG >12 mmHg. CONCLUSIONS: APRI correlates fairly with HVPG in patients of cirrhosis. An APRI score of ≥1.09 seems to have an acceptable accuracy for prediction of high portal pressure. APRI is a fair, bedside, cost-effective parameter for diagnosis of high portal pressure in patients with cirrhosis.
Authors: Woon Geon Shin; Sang Hoon Park; Sun-Young Jun; Jae One Jung; Joon Ho Moon; Jong Pyo Kim; Kyoung Oh Kim; Cheol Hee Park; Tai Ho Hahn; Kyo-Sang Yoo; Jong Hyeok Kim; Choong Kee Park Journal: Gut Liver Date: 2007-12-31 Impact factor: 4.519
Authors: B Nalpas; A Vassault; A Le Guillou; B Lesgourgues; N Ferry; B Lacour; P Berthelot Journal: Hepatology Date: 1984 Sep-Oct Impact factor: 17.425
Authors: T Kawasaki; A Takeshita; K Souda; Y Kobayashi; M Kikuyama; F Suzuki; F Kageyama; Y Sasada; E Shimizu; G Murohisa; S Koide; T Yoshimi; H Nakamura; R Ohno Journal: Am J Gastroenterol Date: 1999-07 Impact factor: 10.864
Authors: L E Adinolfi; M G Giordano; A Andreana; M F Tripodi; R Utili; G Cesaro; E Ragone; E Durante Mangoni; G Ruggiero Journal: Br J Haematol Date: 2001-06 Impact factor: 6.998
Authors: Michiari Okuda; Kui Li; Michael R Beard; Lori A Showalter; Frank Scholle; Stanley M Lemon; Steven A Weinman Journal: Gastroenterology Date: 2002-02 Impact factor: 22.682
Authors: Chun-Tao Wai; Joel K Greenson; Robert J Fontana; John D Kalbfleisch; Jorge A Marrero; Hari S Conjeevaram; Anna S-F Lok Journal: Hepatology Date: 2003-08 Impact factor: 17.425
Authors: W G Shin; S H Park; M K Jang; T H Hahn; J B Kim; M S Lee; D J Kim; S-Y Jun; C K Park Journal: Dig Liver Dis Date: 2007-12-04 Impact factor: 4.088
Authors: Anna Strongin; Theo Heller; Dan Doherty; Ian A Glass; Melissa A Parisi; Joy Bryant; Peter Choyke; Baris Turkbey; Kailash Daryanani; Deniz Yildirimli; Meghana Vemulapalli; Jim C Mullikin; May C Malicdan; Thierry Vilboux; William A Gahl; Meral Gunay-Aygun Journal: J Pediatr Gastroenterol Nutr Date: 2018-03 Impact factor: 2.839