Noninvasive models to predict liver cirrhosis in patients with chronic hepatitis

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Liver International 27 (7), 969–976.

Abstract

CLINICAL STUDIES

Noninvasive models to predict liver cirrhosis in patients with chronic

hepatitis B

Beom Kyung Kim11 Department of Internal Medicine, Yonsei University College

of Medicine, Seoul, Korea*, Sung Ae Kim11 Department of Internal Medicine,

Yonsei University College of Medicine, Seoul, Korea*, Young Nyun

Park2,3,4,52 Department of Pathology, Yonsei University College of Medicine,

Seoul, Korea3 Yonsei Institute of Gastroenterology, Yonsei University

College of Medicine, Seoul, Korea4 Liver Cirrhosis Clinical Research Center,

Seoul, Korea5 Brain Korea 21 Project for Medical Science, Seoul, Korea, Jae

Youn Cheong4,64 Liver Cirrhosis Clinical Research Center, Seoul, Korea6

Department of Gastroenterology, Ajou University College of Medicine, Suwon,

Korea, Hwa Sook Kim1,41 Department of Internal Medicine, Yonsei University

College of Medicine, Seoul, Korea4 Liver Cirrhosis Clinical Research Center,

Seoul, Korea, Jun Yong Park1,41 Department of Internal Medicine, Yonsei

University College of Medicine, Seoul, Korea4 Liver Cirrhosis Clinical

Research Center, Seoul, Korea, Sung Won Cho4,64 Liver Cirrhosis Clinical

Research Center, Seoul, Korea6 Department of Gastroenterology, Ajou

University College of Medicine, Suwon, Korea, Kwang-Hyub Han1,3,4,51

Department of Internal Medicine, Yonsei University College of Medicine,

Seoul, Korea3 Yonsei Institute of Gastroenterology, Yonsei University

College of Medicine, Seoul, Korea4 Liver Cirrhosis Clinical Research Center,

Seoul, Korea5 Brain Korea 21 Project for Medical Science, Seoul, Korea, Chae

Yoon Chon1,3,41 Department of Internal Medicine, Yonsei University College

of Medicine, Seoul, Korea3 Yonsei Institute of Gastroenterology, Yonsei

University College of Medicine, Seoul, Korea4 Liver Cirrhosis Clinical

Research Center, Seoul, Korea, Young Myoung Moon1,31 Department of Internal

Medicine, Yonsei University College of Medicine, Seoul, Korea3 Yonsei

Institute of Gastroenterology, Yonsei University College of Medicine, Seoul,

Korea and Sang Hoon Ahn1,3,41 Department of Internal Medicine, Yonsei

University College of Medicine, Seoul, Korea3 Yonsei Institute of

Gastroenterology, Yonsei University College of Medicine, Seoul, Korea4 Liver

Cirrhosis Clinical Research Center, Seoul, Korea1 Department of Internal

Medicine, Yonsei University College of Medicine, Seoul, Korea

2 Department of Pathology, Yonsei University College of Medicine, Seoul,

Korea

3 Yonsei Institute of Gastroenterology, Yonsei University College of

Medicine, Seoul, Korea

4 Liver Cirrhosis Clinical Research Center, Seoul, Korea

5 Brain Korea 21 Project for Medical Science, Seoul, Korea

6 Department of Gastroenterology, Ajou University College of Medicine,

Suwon, Korea

Correspondence

Sang Hoon Ahn, MD, PhD, Department of Internal Medicine, Yonsei University

College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, Korea

Tel:+82 2 2228 1971

Fax: +82 2 393 6884

e-mail: ahnsh@...

*Both authors have contributed equally to this work.

Abstract

Objectives: Few noninvasive models of chronic hepatitis B (CHB) to predict

liver cirrhosis have been studied. The aim of the current study is to

investigate the diagnostic accuracy of two simple novel models of

spleen–platelet ratio index (SPRI) and age–spleen–platelet ratio index

(ASPRI) in patients with CHB.

Patients and methods: A total of 346 consecutive treatment-naïve patients

with CHB were retrospectively studied. The aspartate to alanine

aminotransferase ratio (AAR), age–platelet index (API), aspartate

aminotransferase to platelet ratio index (APRI), SPRI, and ASPRI were

compared with liver histology.

Results: AAR, APRI, SPRI, API, and ASPRI correlated significantly to

fibrosis stage (all P<0.001). The diagnostic accuracy of ASPRI was the

highest among five tests for prediction of cirrhosis (area under receiver

operating characteristic curve, AUROC=0.893). Using a cutoff score of

ASPRI>12, the presence of cirrhosis could be correctly identified with a

high accuracy (96.3% positive predictive value) in 35 (10.1%) of 346

patients. Similarly, using a cutoff of <5, the presence of cirrhosis could

be totally excluded with 100% of negative predictive value in 120 (34.7%) of

346 patients.

Conclusion: ASPRI was accurate in predicting cirrhosis and screening with

ASPRI has the potential to reduce the number of liver biopsies in CHB

patients.

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